Top 5 Reasons for Denial in Medical Billing

Incorrect/Missing Information

If a submitted claim contains errors or missing information such as patient or insurance details then it will result in the claim getting denied.

Service Not Covered by Insurance

When certain services or procedures are not covered under a patient's insurance plan, they are not eligible for reimbursement according to the patient's insurance policy resulting in the denial of the claim.

Incorrect Coding

The use of incorrect codes, such as incorrect ICD-10 codes or CPT codes also leads to claim denials as the service or treatment code used is wrong or different from what was provided.

Lack of Medical Necessity

If the insurer believes that the procedure or service provided to the patient is not medically necessary then even in that case the claim gets denied.

Duplicate Billing

Submitting the claim twice or multiple times for the same service or procedure is considered duplicate billing and can result in claim denials.