One of the most common denials in behavioral healthcare are incorrect patient information, coverage was terminated, missing billing codes, no timely filing was done, an authorization, or a pre-certification was not done. These denials occur in almost every case of substance abuse treatment. Insurances use medical based criteria to decide if a client's care can be authorized. If a client doesn't meet criteria, claims will be denied for lack of medical necessity.
Some denials are not the fault of the provider or submitting entity. Carriers often deny claims in error to delay payment.
Unfortunately, not all billers complete their work in a timely, and ethical manner. Plans typically give time frames to submit claims. Given these time frames are not met, appeals have to be filed. Inner Circle Billing have staff on hand to provide timely filing for our clients.
If a claim is denied, the provider or client has the opportunity to appeal the decision(s). These appeals take time to process, but they can be won if the correct procedures are followed. At Inner Circle Billing Inc, we differentiate ourselves by relentlessly pursuing payment on denials, and appeals unlike other billing companies.