10 common claim denials and how to prevent them
A short checklist your front desk and billing team can use today. Print it, pin it up and work through it together.
The checklist
Ten frequent, preventable reasons claims are denied, with the step that stops each one and the role that usually owns it.
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Denial prevention checklist from Masscare. Online at masscare.co/resources/denial-prevention-checklist/
| Number | Common denial reason | How to prevent it | Who usually owns it |
|---|---|---|---|
| 1 | Eligibility or coverage not active | Verify eligibility and benefits before every visit, not just at registration. | Front desk |
| 2 | Incorrect or missing patient information | Check name, date of birth and member ID against the insurance card at check-in. | Front desk |
| 3 | No prior authorization or referral | Confirm authorization and referral requirements at scheduling, and track approvals. | Front desk and scheduling |
| 4 | Medical necessity not supported | Make sure the note clearly supports why the service was needed. | Provider |
| 5 | Diagnosis coding too vague or mismatched | Code to the highest specificity the note supports, and link diagnoses to the services billed. | Coding and billing |
| 6 | Wrong or missing modifiers | Review modifier rules by payer before submission. | Coding and billing |
| 7 | Duplicate claim | Check claim status before resubmitting, and use the payer's corrected-claim or reopening process for changes. | Billing |
| 8 | Timely filing missed | Track each payer's filing deadline and work unbilled charges weekly. | Billing |
| 9 | Coordination of benefits problems | Confirm primary and secondary coverage at each visit. | Front desk |
| 10 | Incomplete documentation or missing signature | Complete and sign notes before billing, and use a pre-bill review. | Provider and billing |
How to use this checklist
- Pull your denials from the last few months and sort them by the reason the payer gave.
- Match each denial to a row in this checklist and note which rows come up most often.
- Give each of your top reasons an owner, and agree on the change that will prevent it.
- Check again next month to see whether those denials are going down.
Want help working these? See our revenue cycle management support or book an intro call.
Sources. CMS, Advance Beneficiary Notice of Noncoverage (ABN); X12 Claim Adjustment Reason Codes; 42 CFR 424.44 (Medicare time limits for filing claims). Last checked in October 2026.
This page is general information, not billing, coding or legal advice. Payer rules vary and change over time, so always check current payer and CMS guidance.