The Top 10 Healthcare Insurance Claim Denial Causes


As a healthcare provider, one of the most frustrating facets of working within the industry is inevitably facing denied insurance claims. Whether it happens due to expired insurance, or your employees entering the information incorrectly, it's something that all healthcare providers have to pay particular attention to. If these denied claims are not managed properly, healthcare providers could lose thousands of revenue dollars. 

When managing denials, it's important to understand where they occur most often in the revenue cycle for your organization. Once located, it will be easier to focus more of your resources and employee's time towards that particular facet. Denial causes span the entire revenue cycle, although the largest percentage is associated with the front-end processes. Below we've listed the top ten causes for healthcare insurance claim denials. 

  1. Registration/Eligibility - 23.9%

  2. Missing or Invalid Claim Data - 14.6%

  3. Auth/Pre-Cert - 12.4%

  4. Medical Documentation Requested - 10.8%

  5. Service Not Covered - 10.1%

  6. Other - 9.6%

  7. Medical Coding - 5.8%

  8. Medical Necessity - 5.8%

  9. Untimely Filing - 3.7%

  10. Appropriateness of Care - 3.7%

Managing healthcare insurance claim denials can be a tedious task, we offer a denial management solution called AppealsPlus. For more information, click the button below.