Decoding Denial Code 198: A Guide for Practice Managers

Understanding the Costly Consequence of Denial Code 198
Denial Code 198, a persistent challenge for healthcare providers, practice managers, and owners, indicates that a claim has been denied or reduced due to missing or inadequate precertification. Precertification, also known as prior authorization or pre-approval, is a process required by many insurance companies before certain medical services, procedures, or treatments can be performed.


The High Financial Toll of Denial Code 198
Denial Code 198 directly impacts your bottom line. It results in lost revenue, increased administrative burdens, and potential patient dissatisfaction. To mitigate these negative effects, proactive measures are essential.

Prevention is Key: Mastering Precertification

• Streamline Your Process: Implement efficient workflows for obtaining and documenting precertification information.
• Verify and Document All Precertification Information: Ensure accuracy and completeness of submitted data.
• Leverage Technology: Utilize advanced software to automate precertification and reduce errors.
• Stay Updated: Continuously monitor payer guidelines and policy changes.
• Effective Communication: Communicate precertification requirements to patients.

Overcoming Denial Code 198: Appeal Strategies
While prevention is ideal, denials do occur. When faced with Denial Code 198, develop a robust appeal process. Gather comprehensive documentation, clearly articulate the medical necessity of the service, and persist in pursuing reimbursement.

Partner with Claims Med for Revenue Cycle Success
Claims Med offers specialized revenue cycle management solutions to help healthcare providers thrive. Our expertise in precertification, claims processing, and denial management can significantly improve your financial performance.

Contact us today to optimize your revenue cycle and eliminate the burden of Denial Code 198.

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