California Physicians Worried About Increasing Denials Turn to for Assistance

Tuesday, May 31, 2011

WILMINGTON, Delaware, June 1, 2011 -

Denial rates of California's biggest payers being as high as PacifiCare
– 39.6 percent, Cigna — 32.7 percent, HealthNet — 30 percent, Kaiser
Permanente — 28.3 percent, Blue Cross — 27.9 percent, Aetna — 6.4 percent,
the Denial rates in California are witnessed to be on an all time high, as
reported by California Department of Managed Care. From 2002 through June 30,
, the six insurers rejected 45.7 million claims — 22 percent of all

Contradicting general expectation, the rate of denial by private players
is lesser than the Government program, the Medicare program since its
inception acknowledged the existence of regional variations in medical
practice reimbursements and has sought to accommodate these differences in
adjudicating claims but California denial rates seem to be standing out.

But according to the AMA's National Health Insurer Report Card annual,
Medicare denied medical claims at nearly double the average for private
insurers: Medicare denied 6.85% of claims. The highest private insurance
denier across US was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with
an average denial rate of medical claims by private insurers of 3.88%

Even after these denial ratios dropped one year, the observed trend
suggested that the denial rates are manipulated to suit the requirement of
that fiscal year. Our Medical Billing and Coding specialists suggest the use
of industry best practices to accomplish steady income and reduction in
denial rates

Medical Billers and coders from our consortium having a base in
California (
have had a close look at the trends in denial management in the past decade,
they have managed to discover a pattern or particular reasons for every payer
in the state denying claims.

These billers discovered that Carriers differed in how they treated
incomplete claims, if information required by the payer to process the claim
was missing, the carrier could:

1) Return the claim to the provider, this action of the carrier
is like the claim had never been submitted

2) "Develop" the claim (delay adjudication and try to obtain the
required information by contacting the provider)

3) Deny the claim, the provider then had to resubmit the claim or
go through the appeal process to obtain payment for this service

Denial Management is getting tougher even for specialists as the Carriers
even differed in how they interpreted certain national coverage, most
specialists are confused as the charge raised by them for different carriers
is being treated differently.

A decade long study has also been brought out by expert billers and
coders from, this study reveals resolutions and
check list formats of how to bill for the top five deniers in the state of
California in order to have maximum payout for physicians and minimum

Some of the specialist practices even noticed a denial of 7% of claims
submitted in the current fiscal year, with the reimbursements freezing
physicians groups are definitely looking to manage profitability better. They
are seriously looking for specialists who can handle their denials
specifically. members in California are highly
specialized in working denials and depending upon the age of the claims and
reasons of denial can even provide assurance of collections.

About is the largest 'Consortium of Medical Billers
and Coders,' across the US. The portal brings together hundreds of billers,
with experience in different specialties, on the same platform to service
physicians in their local areas. This network of coders and billers is
growing rapidly and is currently servicing over 50 specialty physicians,
across the US, with the most prominent being Cardiology, (
Mental Health, (
Dental, ( and
General Practice.


    Prerna Gupta, Media Relations
    108 West, 13th street,
    Wilmington, DE 19801
    Tel : +1-888-357-3226
    Email :


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