Why Claim Denials Keep Happening — Even When Coding Looks Correct

One of the most frustrating realities for healthcare practices is receiving claim denials despite accurate coding. While coding errors do cause denials, they are far from the only reason.

Common Non-Coding Causes of Denials

• Inactive or incorrect insurance coverage
• Missing prior authorizations
• Incorrect place of service
• Timely filing violations
• Unclear or incomplete documentation

Payer-Specific Rules Matter

Each payer applies its own policies, edits, and documentation requirements. Claims that pass one payer’s system may be denied by another.

The Cost of Reactive Denial Management

Appealing denials after the fact is expensive and time-consuming. Practices that rely solely on appeals often recover only a portion of lost revenue.

Preventive Denial Management

The most effective strategy is prevention — eligibility checks, authorization tracking, claim scrubbing, and payer rule monitoring.

Reducing denials is not about working harder; it is about building smarter billing workflows.