When a health insurance carrier denies clean claims

March 21, 2008

What can you do when an insurance carrier continues to deny clean claims?

What can you do when an insurance carrier continues to deny clean claims?

First, collect your evidence. List all denials, with their dollar amounts, sorted by type (for example, E/M with procedure code). Next to each, note the rule that supports your correct coding of the claim.

With this information, make your case. Hopefully, you and the carrier's rep can clear up anything your office may be doing that triggers the denials. Be prepared to negotiate over claims that may be debatable. If you're not satisfied with your carrier's response, calculate the percentage of your revenue that comes from this payer. If you can afford to, consider dropping the contract.