Your GI team ran an esophageal study, the report is signed, and the claim goes out under 91040. Three weeks later, it comes back denied. The test was fine.
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The vast majority of 93971 denials have nothing to do with the US. The tech read it correctly. The doctor was correct about the pictures. Then the claim went
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Someone in your practice opens an Aetna denial somewhere, looks at it, and puts it on the pile that nobody has time to read. Revenue goes quiet in that
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A claim can pass every coding check you own and still come back denied. The reason is usually dull. Nobody confirmed the patient’s coverage before the visit, or nobody
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A Humana remittance that is loaded with CO-197 and CO-16 lines costs a practice twice: once for the visit, and once for the staff time spent chasing the money.
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Molina has a separate Medicaid plan in each state it serves, and each plan has its own payer ID, filing window, and definition of a clean claim. And that
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A Blue Cross card at your front desk might belong to one of 35 independent companies. Each has its own portal, own filing deadline, and own definition of a
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Humana Medicare Advantage billing seems deceptively simple until the first stack of denials lands on your desk. On paper, it’s Medicare. In practice, it’s a separate payer with its
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A patient hands over an Aetna card. The front desk scans it, the screen says “active,” and everyone moves on. Ninety days later, the claim comes back denied. The
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Most denied Blue Cross claims never get a second look. The money is there. KFF’s analysis of 2024 HealthCare.gov data found that 19% of in-network claims were denied by
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