What are the two main reasons for denial of payment?

• A. Timely filing and eligibility.
• B. Technical errors and incorrect or incomplete information.
• C. Provider preference and location.
• D. Preauthorization rules.

Answer: (B)

Most payment denials come from administrative data problems and system checks, i.e., technical errors and incorrect or incomplete information. When a claim slides into a payer’s adjudication workflow, any mismatch or missing piece can cause denial. Technical errors include issues the payer’s systems flag during claim scrubbing or processing—things like invalid service dates, incorrect or unsupported procedure codes, missing required fields, or data format problems. If the claim isn’t formatted or populated in a way the payer can validate, it won’t march through to payment.

Incorrect or incomplete information covers data that doesn’t reflect the patient, payer, or service accurately. Examples include wrong or missing subscriber or patient identifiers, an insurance plan that isn’t active, codes that don’t align with the documented service or diagnosis, or lack of supporting documentation to justify the billed service. Even if the service is appropriate, errors in coding or documentation can trigger a denial.

Other options point to specific denial triggers (like timely filing, eligibility, or preauthorization). While those can cause denials, they’re narrower in scope. The two broad, most common drivers of denial are data quality and administrative accuracy—precisely what technical errors and incorrect or incomplete information capture.