Denial Management (Part II)

In general, claims should be paid within 30 days of the date they were send to the insurance. Some claims will not be paid and those unpaid claims must be worked on so that the appropriate reimbursement is received. Unpaid claims are caller accounts receivable.

In order to get theses claims paid, the biller must contact the insurance to find out what happened to the claim and what steps are necessary to get payment.

There are many reasons why claims are not paid. Below you will see a spread sheet for reference of common denial reasons, the associated actions and reference locations to help in the reimbursement process. This is not an exhaustive list, but will act as a help guide as you are learning more and more about medical billing.

Remember denial follow up and following up on accounts receivable must be done constantly to make sure that the practice is getting all the reimbursement they deserve.


To help the reader get a good idea about different denial reasons, their meaning, how to correct denials, and various resources you can use to address denials, follow this link to my 
Denial Management Resource Sheet. 

or

https://docs.google.com/spreadsheet/ccc?key=0As3FvNjmAaz_dGdTUE9pRlUyQ0c5VnFNam12SHhCTnc