Why Claims Get Denied: Common Errors & How We Help

Incorrect or Incomplete Documentation

The Problem: Insurance companies are strict. Missing dates, incorrect patient information, or insufficient session notes are major red flags that lead to denials.

Our Solution: We meticulously review and audit your claims before submission to ensure all information is accurate, complete, and compliant with payer requirements.

Mismatched or Outdated CPT/ICD Codes

The Problem: Using the wrong code for a service or a diagnosis can be a simple mistake with big consequences. Codes change, and keeping up can be a full-time job.

Our Solution: Our team stays up-to-date on all coding regulations to ensure your claims are submitted with the correct codes, minimizing denials and maximizing your reimbursement.

Missing Timely Filing Deadlines

The Problem: Every insurance company has a strict deadline for claim submission. Miss it, and you lose the money for that service—forever.

Our Solution: We implement a systematic process to track all claims and ensure they are filed well within the deadlines, so you never lose revenue due to a missed due date.

Failing to Verify Insurance Coverage

The Problem: A client's insurance plan can change at any time. Billing an old or inactive plan means an automatic denial.

Our Solution: (If this is a service you offer, mention it here) We help you establish processes for verifying and regularly updating client insurance information to prevent this common pitfall.

Understanding Credentialing: Your Path to In-Network

What is Credentialing?

It's the process of verifying your professional qualifications, licenses, and experience to an insurance company. Think of it as your official "stamp of approval" to become an in-network provider.

Why is it so Important?

Without proper credentialing, you cannot bill insurance companies for your services. This limits your ability to accept insured clients, grow your practice, and get paid for the work you do.

The Credentialing Challenge:

The process can be long and complex, often taking months. It involves endless paperwork, strict deadlines, and constant follow-up with multiple insurance companies. It's a huge administrative burden that can distract you from your clinical work.

How We Make It Easy:

We manage the entire process from start to finish. We handle the applications, submit all required documentation, and follow up relentlessly with payers to get you paneled as quickly as possible. We take the stress out of credentialing so you can open your doors to new clients.

General FAQs

How long does the credentialing process take?

The timeline varies widely by insurance company, but it can take anywhere from 90 to 180 days. We work diligently to expedite this process by ensuring all submissions are accurate and by consistently following up.

What is the difference between a denied and a rejected claim?

A rejected claim is a claim that was never even accepted for processing by the payer due to a simple error (like an invalid member ID). A denied claim is a claim that was processed but not paid for a specific reason (e.g., the service wasn't covered). We have strategies for correcting and resubmitting both.

Do you help with re-credentialing?

Yes! Insurance panels require providers to re-attest their information every few years. We can manage this process for you to ensure you remain in good standing and continue to get paid.

I'm a new provider. Can you help me get started?

Absolutely. We specialize in helping new practices get off the ground, handling the initial credentialing and setting up a solid system for claims management from day one.