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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


Additional information required
Charges/claim were split
Filing deadline has passed
Incorrect bill form
Incorrect billing
Missing/invalid attachment

Case management

Not medically necessary


Denial codes—credentialing


Incorrect level of care
Medical records required
Missing/invalid ICD-9-CM code
Service not documented


CPT/HCPCS code missing or invalid


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