In today’s busy healthcare landscape, claim rejections can freeze revenue, drive up administrative burden, and eventually impact patient satisfaction.
At e-care India, we recognize the value of submitting clean claims the first time. That’s why recognizing frequent billing rejections—and learning how to correct them in a hurry—is key to enhancing cash flow and keeping your revenue cycle on track.
Here’s a glance at the most common reasons claims are rejected and how you can fix them effectively.
1. Incomplete or Incorrect Patient Information
The Problem:
Claims are often rejected because of basic mistakes—misspelled names, incorrect date of birth, or invalid insurance ID numbers.
The Fix:
Verify patient information at check-in and intake.
Utilize automated eligibility verification software.
Verify insurance information at each visit.
2. Eligibility Not Verified
The Problem:
Posting a claim before ensuring that the patient is eligible for coverage as of the date of service is a sure ticket to denial.
The Fix:
Conduct real-time eligibility verifications on your clearing house or EHR.
Make pre-appointment verifications run automatically.
Back-up processes during busy days so as not to miss checks.
3. Inaccurate or Inconsistent CPT/ICD-10 Codes
The Problem:
Coding with inaccurate or old procedure/diagnosis codes results in upfront claim rejection or denial.
The Fix
Keep your coding staff current with quarterly code updates.
Utilize billing software that updates code sets automatically.
Perform frequent coding audits to avoid repeated errors.
4. Duplicate Claims
The Problem:
Inadvertently submitting the same claim twice can alert your practice and delay reimbursements.
The Fix:
Install a system to accurately track submitted claims.
Do not re-submit without first checking claim status.
Utilize software that notifies staff of duplicate entries.
5. No Prior Authorization or Referral
The Problem:
Some services and specialty visits must be pre-approved. Without one, submissions risk rejection and delays.
The Fix:
Be aware of which services require authorization by payer.
Keep authorizations electronically stored in the patient’s record.
Educate front-desk and billing staff on how to double-check the requirements prior to service.
6. Timely Filing Limit Exceeded
The Problem:
Every payer has its own file deadlines. Miss those deadlines, and the claim is rejected out of hand.
The Fix:
Monitor payer deadlines and mark upcoming cutoffs.
File claims 48–72 hours post-service whenever possible.
Track outstanding claims through billing dashboards on a daily basis.
7. Coordination of Benefits (COB) Issues
The Problem:
With patients carrying more than one insurance, claims are denied if the incorrect payer is billed first.
The Fix:
Get current COB information with each visit.
Verify primary and secondary insurance coverage.
Alert patients about how COB operates to prevent confusion.
8. Non-Covered Services
The Problem:
Some services are not covered under the patient’s benefit plan, leading to denied payment.
The Fix:
Check the covered services in advance.
Notify patients of possible out-of-pocket expenses.
Clearly document medical necessity to aid appeals when necessary.
9. Inaccurate Provider Information
The Problem:
Claims are denied when provider NPI numbers, taxonomy codes, or enrollment information doesn’t match payer records.
The Fix:
Update all provider credentials throughout the systems.
Double-check that all provider information is up to date prior to claim submission.
Coordinate tightly with credentialing teams to prevent mismatches.
If you’re looking to make your denials management — and your overall revenue cycle — better, you need to build a cross-functional denials work group.
The objectives of the group would be to address denial management in general and overall throughout the revenue cycle. Preventing problems from arising. How the system collaborates is sometimes the problem. Various individuals own various portions of the system and its functions. So, you must bring those multidisciplinary teams together.
How e-care India Keeps You Ahead
At e-care India, we blend industry know-how with intelligent technology to lower your denial rates and increase collections. Our medical billing experts actively track claim statuses, handle rejections, and resubmit clean claims quickly. We make sure you’re not merely responding to rejections, but avoiding them.
Final Thoughts
Medical billing rejections are inevitable, yet they need not be a chronic issue. With the appropriate procedures, software, and staff in place, your facility or practice can reduce rejections, boost reimbursements, and concentrate on what really counts—providing quality care.
Let e-care India help you manage your revenue cycle efficiency, taking the guesswork out of billing.
