Denials feel random, but they rarely are. Across practices and specialties, the same handful of issues drive the majority of rejected claims — and almost all of them are preventable at the front end.
1. Eligibility wasn't verified
Coverage that lapsed, changed, or never covered the service is the single most common reason a claim dies. Verifying eligibility before the visit eliminates a huge share of denials before they happen.
2. Demographic and data-entry errors
A transposed member ID, a wrong date of birth, a misspelled name — payers reject on these instantly. Clean intake data protects everything downstream.
3. Missing prior authorization
Many procedures require approval in advance. Performing the service first and seeking authorization later is a losing bet.
4. Coding errors and missing modifiers
The wrong code, an unbundled service, or a missing modifier can trigger a denial or an underpayment. Specialty-trained coding closes this gap.
5. Late filing
Every payer has a timely-filing window. Disciplined submission and follow-up keep claims from aging out entirely.
Fix these five and most practices see their denial rate fall sharply within a quarter.