Mikayo is the insurance specialist at a physician practice who is responsible for tracking insurance claims submitted to third-party payers and clearinghouses. Especially important is Mikayos tracking unpaid of claims.

To ensure that claims are processed in a timely manner (and payment is received), effective claims tracking requires Mikayo to maintain an electronic copy of each submitted claim, log information about claims submitted in an insurance claims registry, and review remittance advice (remit) documents to ensure that accurate reimbursement was received.

Mikayo notices that the number of denied claims has recently dropped; however, the remittance advice documents still contain reason codes for the limited number of denied claims returned to the physician practice. Ever vigilant about such claims returned to the practice for denials, Mikayo carefully reviews the narrative descriptions of each reason code to determine if denied claims result from coding errors, missing information, or patient coverage issues. It is Mikayos goal to establish a zero percent denial rate for the physician practice.

1) What is the definition of a denied claim?

2) What are reasons for denied claims?