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How to Resolve a Claim Denial

Therapist working to resolve an insurance claim denial

As a mental health practice owner, it can be frustrating and disheartening to have insurance claims denied. Claim denials are no reason to panic; they happen to everyone! These are steps you can take to resolve denied claims and ensure that your patients receive the care they need.

Review the reason for the denial

The first step in resolving a denied insurance claim is to understand why it was denied. Carefully review the denial notice you received from the insurance company to determine the reason for the denial. This may include issues with the diagnosis, treatment plan, or documentation provided. If you have a Practice Solutions biller, you can consult with them on claim denials to utilize their years of experience in managing claim denials.

If you are experiencing denials due to timely filing, non-covered service, or being out of network, read our blog post 3 Standard Denial Reasons and How to Solve Them next.

Gather supporting documentation

Once you have identified the reason for the denial, gather any supporting documentation that may help to overturn the decision. This could include additional medical records, test results, or documentation of the patient's progress.

Appeal the denial

If you believe that the insurance company's decision was incorrect, you can file an appeal. This may involve submitting a written request to the insurance company explaining why you believe the claim should be approved. You may also be able to present your case to an independent review board. When utilizing Practice Solutions’ billing services, the appeal process is something that your biller will manage for you. Your biller will need your assistance with supporting documentation and understanding the circumstance to build a case, but they will be sure to follow the proper filing method for each insurance company to give the best chance of a successful appeal.

Negotiate with the insurance company

If the appeal process is unsuccessful, you may be able to negotiate with the insurance company to reach a resolution. This could involve offering to reduce the charges for the treatment in exchange for the insurance company covering a portion of the costs.

By following these steps, you can take action to resolve denied insurance claims and ensure that your patients receive the care they need. It may take some time and effort, but it is worth it to ensure that your patients receive the treatment they deserve. If you would like to take preventive action to avoid future denials, check out our blog post 3 Tips to Reduce Claim Denials.

If you are experiencing denials and would like help in resolving the issue, contact Practice Solutions today to learn more about our billing services and how they might help to get your practice back on track!

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