A denied claim means extra work and a longer wait to get paid. The good news is that most denials come from a handful of small, fixable mistakes. Here are the five I see most often.
1. The client's information doesn't match. A misspelled name, a wrong date of birth or an outdated member ID is enough to send a claim back. Always copy details exactly from the client's current insurance card.
2. Coverage wasn't checked. Plans change, especially at the start of the year. If a client's plan is inactive, or you bill the wrong insurance company, the claim will be denied.
3. Prior authorization was missing. Some plans require approval before certain services. Without it, the claim can be denied even when the care was needed.
4. Coding errors. The service code should match the session length and your notes. Telehealth sessions may also need the right place of service or modifier.
5. The claim was filed too late. Every insurer sets a deadline for submitting claims, and some are as short as 90 days. Submitting soon after each session keeps you safe.
When a claim is denied: Check the reason on the Explanation of Benefits (EOB), correct the problem, and resubmit or appeal as soon as you can.
If denials are eating into your time, I can help. I work only with Massachusetts mental health practices and handle the follow-up, so you never have to sit on hold. Get in touch through my contact form.
This post is general information. Rules vary by insurance company.
