Introduction
Claim denials are more than just a nuisance—they disrupt cash flow, create rework, and delay patient care. While some denials are unavoidable, most can be prevented with a proactive revenue cycle strategy. In this post, we break down the top 5 most common denial reasons and give you actionable tips to avoid them before they hit your bottom line.

1. Missing or Incorrect Patient Information

Why it happens:
Even one wrong digit in the member ID, date of birth, or address can cause a claim to be rejected.

How to prevent it:

• Implement double-verification at intake and registration

• Use EHR-integrated form validation

• Regular staff training on data accuracy

2. No Authorization or Untimely Authorization

Why it happens:
Failure to get prior authorization, or not updating it after plan changes, leads to automatic denials.

How to prevent it:

• Use a centralized prior authorization tracking tool (like the RCMStreamline Tracker)

• Schedule recurring eligibility checks

• Create payer-specific authorization checklists

3. Coverage Terminated or Not Effective

Why it happens:
Patient’s coverage was inactive on the date of service, or the provider isn’t in-network.

How to prevent it:

• Always run real-time eligibility checks

• Validate insurance status 24–48 hours before service

• Include policy lapse flags in your intake workflow

4. Incorrect Coding or Modifier Issues

Why it happens:
Payers reject claims with unlisted, outdated, or mismatched CPT/HCPCS codes or improper modifiers.

How to prevent it:

• Keep coding tools up to date

• Run pre-submission audits

• Train coders on payer-specific billing guidelines

5. Duplicate Claim Submissions

Why it happens:
Claims submitted more than once for the same service/date without clear correction indicators.

How to prevent it:

• Set up automated duplicate detection in your billing software

• Clearly mark corrected claims with appropriate frequency codes

• Review aging reports before re-submitting

Final Thoughts: Be Proactive, Not Reactive

Denials don’t just hurt your revenue—they slow your team down. By understanding the most common denial reasons and applying these preventative strategies, your team can reduce administrative waste and accelerate reimbursements.

Need help reducing denials?
Our tools and consulting services at RCMStreamline.com are built to simplify and strengthen your entire RCM workflow.

Contact us at support@rcmstreamline.com for additional assistance