Overcoming Denial Code 198: A Comprehensive Guide for Practice Managers and Healthcare Providers

Denial Code 198 is a persistent challenge for healthcare providers, practice managers, and owners. This code indicates that a claim has been denied or reduced due to missing or inadequate precertification, authorization, or notification for a provided service. 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. This article delves into the root causes, financial implications, and prevention strategies for this costly issue.

The High Cost 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.
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Get in Touch with Claims Med
If you're struggling with Denial Code 198 or need assistance with your claims processing, reach out to Claims Med. Our team of experts is here to help you navigate the complexities of healthcare billing and ensure you receive the reimbursement you deserve.