Introduction
Claim denials are one of the biggest challenges in medical billing. They delay payments, hurt cash flow, and increase administrative work. The good news? Most denials are preventable.
Common Reasons for Claim Denials
1. Incorrect Patient Information – Small errors in name, DOB, or insurance ID can lead to rejections.
Fix: Verify patient eligibility before every visit.
2. Coding Errors – Using wrong or outdated CPT/ICD codes causes automatic denials.
Fix: Regular coding audits and certified coders.
3. Lack of Pre-Authorization – Many payers require prior authorization for certain services.
Fix: Maintain a pre-authorization checklist.
4. Duplicate Claims – Submitting the same claim multiple times can trigger denials.
Fix: Track claim submissions carefully.
5. Expired Insurance Coverage – Patient’s policy might have ended.
Fix: Always check insurance eligibility in real-time.
Conclusion
At MedProAlign, we reduce denials by 30–40% for our clients through accurate billing, coding, and proactive denial management.