Submitting clean, accurate medical claims should be a straightforward process—but in reality, it’s one of the biggest challenges healthcare providers face. Every error, omission, or delay in claim submission can lead to denials, rework, and lost revenue.
Even small practices spend hours chasing down rejected claims, while large healthcare systems invest heavily in correcting preventable mistakes. Understanding the most common claim submission issues—and how to prevent them—can transform the way a practice manages its revenue cycle.
This article breaks down the top seven claim submission issues doctors wish they could eliminate, along with practical solutions, real-world examples, and proven strategies to achieve smoother reimbursements.
Why Clean Claim Submission Matters
A “clean claim” is one that contains all required information, uses correct codes, and is submitted within payer timelines—without needing corrections or extra documentation.
According to the Medical Group Management Association (MGMA), up to 65% of claim denials are never resubmitted, meaning millions of dollars are left uncollected every year. Submitting cleaner claims from the start saves both time and money.
Why Labs Lose Revenue (and Don’t Notice It Right Away)
You don’t need fewer patients — you need fewer errors. Labs typically lose money because of small, fixable inefficiencies:
High Denial Rates – Often caused by incomplete data or missing pre-authorizations.
Manual Billing Workflows – Human error from retyping or missed claims can be costly.
Uncollected Balances – High-deductible plans leave more responsibility on patients.
Slow Cash Flow – Late claim submissions and delayed payer responses stall revenue.
The average cost to fix a denied claim can be over 10x what it costs to file it correctly the first time. So prevention isn’t just smarter — it’s more profitable.
Common Claim Submission Challenges at a Glance
Here’s a quick summary of the most frequent claim submission issues medical practices face, their root causes, and how to fix them:
Missing or Incorrect Patient Details – Often caused by registration or data entry mistakes. These errors lead to instant claim rejections. Always verify patient demographics and insurance information before submission.
Coding Inaccuracies (ICD-10/CPT/HCPCS) – Outdated, mismatched, or missing codes can cause denials or underpayments. Conduct regular coding audits and provide ongoing coder training to maintain accuracy.
Insurance Eligibility Errors – Submitting claims for inactive or incorrect insurance plans results in non-reimbursable claims. Use real-time eligibility verification before every appointment.
Missing Documentation – Claims lacking required clinical notes, prior authorizations, or test results are denied for medical necessity. Always attach all necessary documentation prior to submission.
Duplicate Claim Submissions – Caused by manual re-entry or system errors. Duplicate claims are rejected by payers. Prevent this by tracking submissions and maintaining detailed claim logs.
Untimely Filing – Missing payer-specific deadlines leads to permanent revenue loss. Maintain a filing calendar and set automated reminders to submit claims on time.
Poor Claim Tracking and Follow-Up – When claims aren’t monitored after submission, they can go unpaid or get lost. Implement automated claim tracking tools and consistent follow-up workflows to ensure every claim is resolved.
1. Missing or Incorrect Patient Information
It sounds simple, but inaccurate patient data is one of the top reasons for claim rejections. A single typo in a date of birth, policy number, or insurance plan can lead to a “patient not found” error.
Example:
If a claim lists “Jonathan Smith” but the insurance record says “Jon Smith,” the system might not recognize the match—resulting in a rejection.
How to Prevent It:
Double-check patient demographics during each visit.
Use automated eligibility verification tools to validate insurance details in real time.
Encourage patients to bring updated insurance cards whenever coverage changes.
Quick Tip: Even a 1% improvement in registration accuracy can reduce rejections dramatically across a billing cycle.
2. Coding Errors: ICD-10, CPT, and Modifier Mistakes
Coding errors continue to plague medical billing teams despite advancements in electronic systems. Each payer has unique coding requirements, and even minor mistakes can disrupt payment.
Common Mistakes Include:
Using old or deleted CPT codes
Forgetting required modifiers
Linking procedures to the wrong diagnosis codes
Overcoding or undercoding unintentionally
Solution:
Schedule quarterly internal coding audits.
Subscribe to AMA and CMS coding updates.
Cross-check diagnosis-procedure relationships before submission.
Example:
A clinic billing for physical therapy accidentally used an outdated CPT code for manual therapy. After updating their coding software and retraining staff, their denial rate dropped significantly within two months.
3. Eligibility Verification Problems
Nothing frustrates doctors more than discovering a patient’s insurance was inactive after care was already provided. Eligibility errors often occur when policies change mid-year or patients forget to share updates.
Why It Happens:
Expired coverage
Coordination of benefits not updated
Incorrect payer entered during registration
How to Avoid It:
Conduct real-time eligibility checks before every appointment.
Re-verify insurance for returning patients after 30–60 days of inactivity.
Integrate eligibility verification into scheduling systems for automatic alerts.
Pro Insight: Many practices now use electronic eligibility tools that can confirm active coverage and copay details instantly, saving hours of manual work.
4. Missing or Insufficient Documentation
Claims can be perfectly coded but still denied if they lack adequate documentation. Payers often require proof of medical necessity, such as clinical notes, lab reports, or prior authorizations.
Typical Documentation Gaps:
No prior authorization for imaging or therapy
Missing progress notes
Lack of supporting test results
Best Practices:
Create checklists for each service category (e.g., imaging, surgery, therapy).
Train staff to attach documentation before claim submission.
Maintain EHR templates that prompt clinicians to enter required details.
A simple checklist-based approach can prevent most documentation-related denials before they occur.
5. Duplicate Claim Submissions
When claims appear unpaid, staff may resend them “just in case.” Unfortunately, resubmitting without checking claim status often leads to duplicate claims, which are automatically rejected by payers.
Why It Happens:
Poor communication between billing and AR teams
Delays in payer responses
Lack of visibility in claim tracking systems
How to Prevent It:
Implement a centralized claim tracking system.
Allow at least 14–21 days for payer response before resubmitting.
Review payer portals or clearinghouse dashboards before any resubmission.
This one change not only prevents rejections but also protects practices from compliance risks associated with accidental duplicate billing.
6. Missing Filing Deadlines
Every insurance payer has its own claim filing deadline—ranging from 90 days to one year from the date of service. Missing these timelines means lost revenue that can’t be recovered.
Root Causes:
Claims stuck in draft or correction stages
Delay in provider documentation or coding review
Lack of awareness of payer-specific timelines
Fix It With:
A payer filing calendar displayed for billing staff.
Automated alerts for claims nearing deadlines.
A “first in, first out” (FIFO) approach to claim processing.
Example:
A mid-sized practice that started tracking payer deadlines within its billing software reduced late claim write-offs by 70% in just one quarter.
7. Poor Claim Tracking and Follow-Up
The work doesn’t end after submitting a claim. Many practices lose revenue because no one follows up on unpaid or underpaid claims.
The Problem:
No standardized follow-up workflow
Limited staff to manage accounts receivable
Lack of automation or reporting visibility
Solutions:
Use automated claim status updates that sync with payer systems.
Set follow-up checkpoints (e.g., 15, 30, and 45 days post-submission).
Train a dedicated AR team to handle appeals and partial payments.
Timely follow-up not only speeds up payments but also identifies trends—such as recurring payer issues or documentation gaps—that can be fixed proactively.
Bringing It All Together: A Case Insight
Consider a multi-specialty practice facing persistent denials for years. The main culprits? Coding mismatches, outdated payer information, and late filing.
By implementing automation, periodic audits, and stricter front-end verification, they achieved the following in four months:
Clean claim rate increased from 82% to 97%
Denial rate dropped below 5%
Payment turnaround time improved by 40%
This case proves that small, consistent improvements across the claim submission process can dramatically boost a practice’s financial performance.
Final Thoughts
Doctors shouldn’t have to spend their valuable time fixing billing problems that can be prevented with the right systems and training. A well-structured Revenue Cycle Management (RCM) process ensures every claim moves smoothly from submission to payment—without unnecessary friction.
If you’re looking for professional guidance or a comprehensive review of your claim submission workflow, Akshar MediSolutions offers tailored RCM solutions designed to minimize denials and improve cash flow efficiency.
Frequently Asked Questions
The most common claim submission errors include incorrect patient details, missing documentation, invalid or outdated codes, duplicate claim submissions, and missed filing deadlines. Even small data entry mistakes can lead to claim rejections or payment delays.
Doctors can reduce claim denials by verifying patient eligibility before each visit, staying updated with ICD-10 and CPT coding changes, and ensuring that claims include all required documentation. Using automated claim tracking and conducting regular billing audits also helps minimize rework.
Claim accuracy ensures that payers can process claims quickly and without manual intervention. Clean, accurate claims reduce denials, speed up reimbursements, and improve overall cash flow—making claim accuracy a cornerstone of effective Revenue Cycle Management (RCM).
It’s recommended that medical billing teams perform coding audits at least once per quarter. Regular audits help identify recurring mistakes, ensure compliance with payer rules, and maintain accuracy as code sets and regulations change.
Denied claims should be reviewed immediately to identify the cause—whether it’s missing information, coding issues, or payer errors. Once corrected, they should be resubmitted within the appeal window. A structured denial management process ensures that no revenue is lost unnecessarily.