Denials are cheapest to fix before the claim exists. Here are eight causes we design against in the claims module.
In short: Common ABA denials include expired or missing authorizations, billing past approved units, unsigned session notes, wrong codes or modifiers, ineligible coverage, late submissions, duplicate claims and unmatched remittances. Software prevents them with authorization-linked scheduling, note gating, a claim scrubber and a denial work queue.
1. Expired authorization
Prevent by alerting before expiry and showing lapse on the board.
2. No authorization line for the service
Warn at scheduling and block completing the event until a line exists, with an admin override that needs a reason.
3. Billing beyond approved units
Block completing events beyond the line total.
4. Unsigned session note
Keep the session in “note required” until the note is signed, then mark it billable.
5. Wrong code, modifier or diagnosis
Use payer rules and a claim scrubber to flag mismatches before submission.
6. Eligibility problems
Record eligibility checks against the client insurance and surface changes.
7. Late submission
Capture charges nightly and keep a held-charges list so nothing waits silently.
8. Unmatched remittances
Post 835 payments to claims automatically and flag unmatched ones for review.
Frequently asked questions
Does software guarantee payment?
No. It reduces avoidable errors. Payers decide payment.
Related: software for medical billing companies.