One of the most frustrating insurance denials is getting denied for no apparent reason. Several carriers (including big nationwide carriers) deny a small percentage of claims for no reason. Your biller checks the claim detail - diagnoses, procedure codes, modifiers, provider details, etc., and cannot determine why it is being denied. Trying to resubmit will simply get a "duplicate claim" denial. The only recourse is to make a call. After being put on hold for hours, an insurance representative will inform that they will "send the claim back for reprocessing."
In today's tight employment scenario, such tactics yield results for the insurance companies - who will spend $30 to get a $90 claim paid? There are several such denials - down-coding, denial of medical notes, etc. that take enormous time, and the process makes it financially infeasible. However, ignoring these denials will ultimately hurt the practice.
Glenwood Systems is committed to fighting these denials despite the barriers erected by the insurance companies.
