Claim denials can be a major headache for behavioral health providers, leading to delayed payments and additional administrative burdens. Understanding the common reasons for denials can help you take proactive steps to prevent them. In this post, we’ll explore the top five reasons behavioral health claims get denied and how to address them.

1. Incorrect or Missing Information

One of the most common reasons for claim denials is missing or incorrect information, such as patient demographics, diagnosis codes, or insurance details.

Solution: Double-check all information before submission and use a checklist to ensure nothing is overlooked.

2. Authorization Issues

Certain services require prior authorization, and failing to obtain it can result in a denial.

Solution: Verify authorization requirements for each service and payer, and keep a log of authorizations obtained.

3. Coding Errors

Using outdated or incorrect CPT, ICD-10, or POS codes can trigger a denial.

Solution: Stay current on coding changes and provide ongoing training for your billing staff. Regularly audit claims to identify and correct coding issues.

4. Eligibility and Coverage Problems

If a patient’s insurance coverage is not verified before the service is provided, you risk claim denials due to ineligibility or out-of-network status.

Solution: Check eligibility and coverage details for every patient before their appointment and re-check if their insurance information changes.

5. Timely Filing Limit Exceeded

Each payer has a specific timeframe within which claims must be submitted. Submitting after the deadline will result in a denial.

Solution: Track submission deadlines for each payer and implement a system for timely filing reminders.

Conclusion:

Reducing claim denials requires a proactive approach, from ensuring accurate information and proper authorizations to staying up-to-date with coding changes. By addressing these common issues, you can improve your claim acceptance rate and reduce delays in payment.

Struggling with frequent denials? Contact us to troubleshoot and resolve your claim issues.