If your claim is denied, review the payer-provided Explanation of
Benefits (EOB)
detailing the
reason for denial. Common reasons for claim denial or underpayment include:
Lack of details on the patient’s history and clinical course
Incorrect billing codes or omission of modifiers
Incomplete documentation supporting the medical necessity and/or codes
used
Inaccurate description of services provided
To appeal a denial:
Review the rationale for denial and discuss it with the payer.