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Take the Time to Understand Your Role in the Denials Management Process

Denials are an ever-present challenge that most hospitals struggle with on a daily basis. However, knowing what causes the denials and which departments are responsible is an important part of solving the problem.

Experts say a successful denials management strategy is one in which each department plays a role in the solution. Do you know what your role is? Use the following chart to help establish your road map for success.

Root Cause Area	Denial Code Description
Billing	Additional information required Charges/claim were split Filing deadline has passed Incorrect bill form Incorrect billing Missing/invalid attachment
Case management	Not medically necessary
Credentialing	Denial codes—credentialing
HIM	Incorrect level of care Medical records required Missing/invalid ICD-9-CM code Service not documented
HIM/CDM	CPT/HCPCS code missing or invalid
Registration	Benefits exhausted COB/primary carrier coverage Coverage not in effect on date of service Invalid services Not a covered benefit Not a covered dependent Patient unidentified/need ID Unauthorized hospital visit Workers’ compensation liable

— Source: Christine Armstrong, principal with Deloitte & Touche