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Expertise

Technical Denials

Issued as a result of a claim’s processing by the insurance carriers, these types of denials tend to be more administrative in nature and issued on a remittance advice opposed to a formal letter. Very little information is provided to explain the denial, except a series of remark codes and a corresponding key to briefly indicate the reason for no payment. Due to the limited amount of information provided on the remittance advice, a call will usually have to be placed to the insurance carrier’s provider service line. To resolve these denials expeditiously, an understanding of how to read a remittance advice, as well as a comprehension of all applicable contractual and regulatory obligations (by both payer and provider) will be critical. Denials issued on a remit may be as straightforward as an incorrect or incomplete insurance identification number, or be as a result of more complex problems with the claim including but not limited to:

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