Post-service denials

Insurance claims may be denied for many reasons. If your Mayo Clinic claim has been denied, a good first step is to consult the list below for suggestions on next steps toward resolving your claims issue.

• Authorization number is missing or invalid
• Benefits maximum for this time period has been reached
• Care may be covered by another payer per coordination of benefits
• Charges exceed your contracted/legislated fee schedule
• Claim or service lacks information for payment processing
• Insufficient or incomplete requested information
• Lack of authorization or pre-certification prior to services
• Lack of referral authorization
• Motor vehicle or other liability insurance
• Multiple physician assistants
• Not covered by this payer or contractor
  • Psychiatry services
  • Dental services
• Noncovered services or diagnosis code
• Not an eligible dependent based on our records
• Not medically necessary
• Patient cannot be identified as our insured
• Service deemed experimental/investigational or not proven to be effective
• Usual and customary reductions (UCR)
• Work-related injury or illness

You may also wish to review some general hints on insurance appeals.