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RemitDATA Market Stats

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Top 5 Denied Procedures Across All Major Specialties in the U.S.

  1. Procedure: 99213 Established patient visit, level 3 exam » Unexpected Denial Rate: 6%
  2. Procedure:  36415 Routine venipuncture - blood capture » Unexpected Denial Rate: 13%
  3. Procedure:  99214 Established patient visit, level 4 » Unexpected Denial Rate: 6%
  4. Procedure: 99000 Specimen handling office-lab » Unexpected Denial Rate: 56%
  5. Procedure: 99232 Subsequent hospital care, level 2 » Unexpected Denial Rate: 10%

Results based on RemitDATA's outpatient ERA database covering approximately 25% of all outpatient providers across all major specialties in U.S. from 2/25/2013-6/3/2013

Top 10 Reasons for Denials on the Top Five Denied Procedures

  1. Reason Code: 97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. » Eligibility/Verification Issues
  2. Reason Code: 18 Duplicate claim/service.
  3. Reason Code: 16 Claim/service lacks information which is needed for adjudication.
  4. Reason Code: 109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. » Eligibility/Verification Issues
  5. Reason Code: 27 Expenses incurred after coverage terminated. » Eligibility/Verification Issues
  6. Reason Code: A1 Claim/Service denied. At least one Remark Code must be provided.
  7. Reason Code: 96 Non-covered charge(s). At least one Remark Code must be provided.
  8. Reason Code: 29 The time limit for filing has expired. » Eligibility/Verification Issues
  9. Reason Code: B13 Previously paid. Payment for this claim/service may have been provided in a previous payment.
  10. Reason Code: 24 Charges are covered under a capitation agreement/managed care plan. » Eligibility/Verification Issues

Results based on RemitDATA's outpatient ERA database covering approximately 25% of all outpatient providers across all major specialties in U.S. from 2/25/2013-6/3/2013




     

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