CEO SUMMARY: While the number of denials is not going up, the reasons that private payers deny claims are becoming more complex and time-consuming to appeal. After reviewing noteworthy trends among payers, learn a three-level approach to appeals that may lead to greater success and speed up the process. AS PAYERS ADOPT NEW STRATEGIES IN […]
Clinical Labs Battle Complex Claims Denials
Shifting policies and a lack of transparency from payers create turmoil for laboratory revenue
- By Stephen Beale
- > From the Volume XXXII, No. 11 - August 4, 2025 Issue
- Tags: Aetna, Amerigroup, Anatomic pathology, avalon healthcare solutions, Blue Cross Blue Shield, Cigna, Claim denials, Companion diagnostics, CPT® codes, denial codes, Diana Richard, EDI, electronic data interchange, executive war college, federal National Correct Coding Initiative, HIPAA, hospital outreach, Humana, lab intelligence, LCD, local coverage determination, medical billing, medical necessity, medically Unlikely Edits, Medicare, Medicare Advantage, molecular diagnostics, molecular lab, MUE, national coverage determination, NCCI, NCD, next generation sequencing, Prior authorization, RCM, revenue cycle management, Stephanie Sessions, UnitedHealthcare, waiver of liability, xifin
