Access detailed guides on common medical billing denials to strengthen your Revenue Cycle Management (RCM) knowledge.
1. No Claim On File
Learn why an insurance payer cannot locate a submitted claim. This guide covers claim submission verification, clearinghouse reports, timely filing considerations, and the correct process for resubmitting or tracing missing claims.
2. Capitation
Understand how capitation payment agreements work and why claims are often denied when services are covered under a capitated contract. Learn how to identify capitated providers, verify contracts, and determine the appropriate billing pathway.
3. Deductible
Discover how patient deductibles affect claim payments and when financial responsibility transfers to the patient. This guide explains deductible calculations, EOB interpretation, and best practices for patient billing.
4. Member Not Found
Identify the eligibility, enrollment, and demographic issues that cause member lookup failures. Learn how to verify insurance coverage, correct patient information, and resolve eligibility-related denials.
5. Claim Paid
Understand why a claim is marked as already paid and how to verify payment details using the Explanation of Benefits (EOB), Electronic Remittance Advice (ERA), and claim history before taking further action.
6. Offset
Learn how insurance payment offsets and recoupments work. This guide explains how to trace offset transactions, identify the original overpayment, reconcile adjusted amounts, and resolve outstanding balances accurately.
Once you’re comfortable identifying and resolving these denials, check out Medical Billing Modifiers — modifier errors are one of the most common root causes behind several of the denials above.