Appeals & Denials
If a claim is denied, the facility, or provider, has the opportunity to appeal the decision(s). These appeals take time to process, but they can be won if the correct procedures are followed. At Inner Circle Billing, we differentiate ourselves by relentlessly pursuing payment on denials, and appeals, unlike other billing companies.
Unfortunately, not all billers complete their work in a timely, and ethical manner. Plans typically give time frames to submit claims. Given these time frames are not met, appeals have to be filed. Inner Circle Billing has specialized staff on hand to provide timely filing for our clients.
Some denials are not the fault of the provider or submitting entity. Carriers often deny claims in error to delay payment. Inner Circle Billing fights aggressively for claims to get paid for services rendered.
Some of the most common denials in behavioral healthcare are incorrect patient information, coverage was terminated, missing billing codes, no timely filing was done, and an authorization or a pre-certification was not completed. These denials occur in almost every case of substance abuse and mental health treatment. Insurances use medical based criteria to decide if a client’s care can be authorized. If a client does not meet criteria, claims will be denied for lack of medical necessity. Inner Circle Billing professionals aide our facilities, or providers, to ensure that denials are non-existent.