In today’s healthcare landscape, claim denials are more than just an administrative nuisance—they directly impact cash flow, disrupt operations, and create extra work for both billing teams and providers. Despite advances in electronic health records and automated billing software, denial rates remain a major challenge for practices of all sizes.
This guide highlights the 10 most common claim denials seen across medical practices, clinics, and healthcare organizations. From eligibility issues to coding errors and missing documentation, we’ll explain what causes these denials—and more importantly—how to proactively avoid them. By knowing these red flags in advance, you can strengthen your billing process, reduce resubmissions, and maximize reimbursement.
The 10 Most Common Claim Denials:
Are claim denials clogging up your cash flow? Tired of chasing down payments and decoding cryptic rejection codes? Wondering why your claims keep bouncing back?
Claim denials are the bane of every healthcare provider’s existence. Whether you run a small practice or a large organization, denied claims can disrupt your revenue cycle and cause endless frustration. At MABS, we know how stressful it is to see your hard work go unpaid. Understanding the most common reasons for claim denials can help you prevent them and keep your revenue flowing smoothly. Let’s break down the top 10 claim denials, and—because we all need a laugh—add some dry humor along the way.
1. Incorrect Patient Information
Imagine sending a claim for “Jonh Smith” instead of “John Smith.” The insurance company doesn’t care if it’s a typo, a missing digit, or an autocorrect fail. Incorrect patient details are the number one reason claims get denied. Even the tiniest error can send your claim on a one-way trip to the rejection bin.
Misspelled names can turn your claim into a “Where’s Waldo?” puzzle for payers.
Wrong birth dates can make a 30-year-old look like they’re eligible for Medicare. (Spoiler: they’re not.)
Incorrect insurance ID numbers can make your claim disappear faster than socks in a dryer.
Double-check patient information before submitting claims. It might save you hours of detective work later.
2. Missing or Invalid Codes
Medical billing codes are like passwords to payment. Get them wrong, and you’re locked out. Using outdated, missing, or invalid codes is a surefire way to get denied.
Submitting a claim with “XYZ123” as a code? Sorry, that’s not a thing (unless you’re billing for alien abductions).
Forgetting to update to the latest ICD-10 or CPT codes? That’s like showing up to a costume party in last year’s outfit—no one’s impressed.
Stay updated on coding changes, and make sure your codes are accurate and complete.
3. Services Not Covered by the Payer
Sometimes, insurers just don’t want to pay for certain services. Submitting claims for non-covered services is like ordering sushi at a pizza place—you’re not getting what you want.
Be aware of each payer’s coverage policies. Not every insurance plan covers massage therapy for “work-related stress.”
Verify benefits before providing services. It’s better to know up front than to argue later.
Always check coverage before you deliver care. Your future self will thank you.
4. Authorization or Referral Required
Some services require prior authorization or a referral. Submitting a claim without the right paperwork is like trying to board a plane without a ticket—you’re not getting anywhere.
No prior authorization? Denied.
No referral from the primary care provider? Denied.
Make sure you have all required approvals before you submit a claim. Otherwise, you’ll be stuck in the airport of claim denials.
5. Duplicate Claims
Submitting the same claim more than once might seem like a good idea if you’re feeling ignored. Unfortunately, payers see it as a red flag. Duplicate claims are almost always denied.
Don’t hit “send” twice just because your computer froze. That’s what IT support is for.
Keep track of submitted claims to avoid accidental duplicates.
Remember, persistence is good—but not when it comes to duplicate billing.
6. Late Claim Submission
Every payer has a deadline for submitting claims. Miss it, and your claim is about as useful as expired milk.
Some payers give you 90 days. Others, 180 days. Know your deadlines!
Set reminders so you don’t miss out on payment because of a simple oversight.
Timeliness is next to claimliness.
7. Coordination of Benefits Issues
When a patient has more than one insurance plan, things get complicated. If you don’t coordinate benefits correctly, your claim might end up in limbo.
List the primary and secondary insurers accurately. Mixing them up is like putting your shoes on the wrong feet—uncomfortable for everyone.
Include all necessary information to show who pays first.
Coordination is key. Otherwise, your claim might wander the insurance wilderness forever.
8. Non-Medically Necessary Services
If the payer decides the service wasn’t medically necessary, your claim could get the boot. It’s not personal—they just want proof.
Document the medical necessity of every service. “Because I felt like it” doesn’t count.
Include supporting documentation with your claims.
Give payers a reason to say “yes.”
9. Incorrect Provider Information
Claims with incorrect or incomplete provider details get denied faster than a teenager’s curfew extension request.
Make sure your NPI, tax ID, and address are accurate on every claim.
Update your information with payers regularly.
If your provider info is wrong, your payment might go to someone else—or nowhere at all.
10. Bundling and Unbundling Errors
Some services must be billed together (bundling); others must be billed separately (unbundling). Get it wrong, and your claim is toast.
Bundling two services that should be separate? Denied.
Unbundling services that should be together? Also denied.
Follow payer guidelines for bundling and unbundling to avoid unnecessary denials.
Claim denials can be frustrating, but they’re not unbeatable. By understanding the most common reasons for denials, you can take proactive steps to prevent them. Double-check patient and provider information. Stay up to date on coding. Verify coverage and authorizations. And always submit claims on time.
