Here are the top 10 reasons why the most commonly billed procedures in ambulatory surgical facilities were unexpectedly denied based on data collected between November 5, 2012 and February 11 2013 by RemitDATA, an independent source of comparative analytics for reimbursement, utilization and productivity data. The database houses 25 percent of all national outpatient remits.
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.
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