10 Common Reasons Top ASC Procedures Are Unexpectedly Denied
1. Claims or service lacks information which is needed for adjudication.
2. Duplicate claim or service.
3. Procedure or treatment is deemed experimental or investigational by the payor.
4. The benefit for this service is not included in the payment or allowance for another service or procedure that has already been adjudicated.
5. These are non-covered services because they are not deemed "medically necessary" by the payor.
6. Pre-certification, authorization or notification is absent.
7. Claims were not covered by the payor or contractor. You must send the claim to the correct payor or contractor.
8. Payment for the claim or service may have been provided in a previous payment.
9. The patient or insured health identification number and name do not match.
10. Coverage or program guidelines were not met or were exceeded.
Learn more about RemitDATA.
More Articles on Surgery Centers:
5 Ways to Boost Profits at Cash-Strapped ASCs
Outlook for De Novo ASCs in 2013 and Beyond: Q&A With Luke Lambert of ASCOA
5 Key Metrics Profitable ASCs Track
© Copyright ASC COMMUNICATIONS 2016. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
- GI leader to know: Dr. Russell Cohen of The University of Chicago Medicine
- NJ Association of Ambulatory Surgery Centers sends members to Capitol Hill in support of access to care bills: 3 takeaways
- Senior in home care start-up Hometeam names CMO: 4 takeaways
- Pain Con Pain Consultants at Piedmont receives accreditation: 3 takeaways
- Obalon Therapeutics 3 balloon capsule system safe, effective for obesity treatment: 5 takeaways