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Why was my claim denied?

New York -- May 06, 2024

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Claim denial for home care agencies are a necessary part of business. While it can be frustrating, it’s important ot deal with the issue at hand quickly. There are also steps to take which can help to prevent claim denials in the future. But first let’s look at why a claim might be denied in the first place.


Most of these errors can take place during the patient intake form. One thing to remember is to make sure that all information is recorded correctly with double checks and peer review. 


  1. Listing the wrong payer 

  2. Not having the right authorizations 

  3. Information missing from forms 

  4. Issues for eligibility 

  5. Error in which payers require authorization


Those are a few reasons why a claim might be denied. 


So what can you do? 


One step for preventing or reducing claim denial is to have a dedicated staff member to review claims. It is crucial to catch errors before they the claim is submitted. Having dedicated staff for claims review is important because otherwise there is a risk of someone juggling through different tasks. Claims are a complex task and rushing through them is not going to cause problems. 


The other step you can take is try to handle claim denials as quickly as possible. If you have a long backlog and delay in handling the issue, there is less chance that the claim will be approved. Claims that are denied have a lower leverage, so you want to make sure the issue can be taken care of as soon as possible. 


Also you need proper technology for processing claims. 


How Carecenta can help 


Carecenta has support for all indurance companies including MLTC, CHAR, and Medicaid. There is also seamless integration with Clearing Houses such as MDOL and RelayHealth. The billing work can be done in minutes with automated audits. Cardcenta also offers e-Remittance with automated EOP processing. You download nd fill out all necessary forms within minutes as well. Furthermore, Carecenta allows for automated rebilling, which gives you full control over the money through remittance.


Support your claims teams with Carecenta, and book a demo to learn more!