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What do I do if my claim is denied?

A Denied status indicates that the payer has processed the claim, but denied payment. This could be due to the way the claim was coded or because it's not a reimbursable claim based on your contract with the insurance company or the client's plan.

If you’re enrolled to receive payment reports, you can view the denial reason by clicking Claim Details at the top of the denied claim. Scroll down to the payment report and place your mouse cursor over the ? under Client Responsibility to display the denial reason.

Denied claim reason given by clicking ? icon

If you’re not enrolled in payment reports or if additional clarification is needed for the denied claim, please contact the payer directly and use the member ID, date of service, and total billed amount to have the representative locate the claim in question. They will be able to further detail why the claim was denied and the correct steps needed in resubmitting the claim for it to be successfully processed. The payer doesn’t provide our team with additional information regarding the denial.

Note: For additional information on how to submit a corrected claim, please refer to this guide: How to submit a corrected claim?

 

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