Though physicians are very careful in filing the claims to the payer, still most of their claims are denied.

Here are top 5 reasons for claim denials which most physicians face but either realise later or are not able to figure out:

Duplicate claims:

Have you ever tried to resubmit a claim for which you have not received any response? If yes then you shouldn’t, as it creates confusion for the payer and may ending up as a duplicate claim.

Claims/service lacks information:

Make sure you get CO16 code which says information is incomplete to process the claims. A remark code is required for additional information.

Benefit for this service is included in the payment:

The insurance company denies the claim for a service as it has already paid for another service on the same date (as a part of bundled service).

At least one remark code must be provided:

This may include either a Remittance Advice Remark Code or NCPDP Reject Reason Code.

The time limit for filing has expired:

The maximum filing limit of Medicare is 2 years and minimum 1 year. If you have filed your claim within the time limit then appeal it with a required proof.