Common Denial Reasons and Action Steps Needed to Resolve

At Zaya, we’re committed to making sure your hard work translates into timely payments - because nothing is more frustrating than a claim denial messing up your day (and your cash flow). We’re here to help you reduce denials and keep the revenue coming in smoothly. Below, we’ve broken down common denial reasons and how to avoid them.

THE TIME LIMIT FOR FILING HAS EXPIRED

This denial message means that the claim was submitted past the payer’s allowed time frame for filing, so they won’t process or pay it. To ensure claims are paid successfully and on time, Zaya requires all claims to be received within 30 days of the date of service (DOS). If there is a justifiable reason for submitting claims past timely filing, please email support@zayacare.com to assess. 

DUPLICATE CLAIM OR SERVICE

This denial means the claim was flagged as a duplicate by the payer, either already processed or currently under review for similar services. To avoid this, double-check that you’re only sending each claim to Zaya once. If you need to send a correction to a claim that was already submitted, please email support@zayacare.com with the details of the correction and we will handle that for you. 

MISSING DOCUMENTATION

This denial indicates that required documentation was either missing, incomplete, or not provided on time. Once Zaya receives a claim, we submit it to the payer. If additional information is needed, we’ll reach out to your practice directly to upload it here. Providing the requested details to our team quickly ensures the process stays on track. NOTE: This link is also on the Portal under Payouts.

WORKERS COMPENSATION or ACCIDENT RELATED INJURIES 

This denial indicates that the patient's primary medical insurance does not believe they are responsible for the services due to a work or accident related injury. Using injury codes as the primary diagnosis often leads to claim rejections because payers prefer to see the functional limitations being addressed during therapy sessions.

Injury codes can easily be identified by their leading S or T - payers accept these codes in secondary, tertiary or quaternary positions on the claim.  You can review the full set of injury codes here. Please also ensure that your clinical documentation reflects the cause of requirement treatment. 

ELIGIBILITY OR COORDINATION OF BENEFITS

Eligibility: This denial means that the health plan believes the patient is not eligibility for coverage.  In order to correct this, we will need you to contact the patient to verify that we have the most up to date insurance information on file. Once this information is received from the patient, please email support@zayacare.com with the applicable information to resolve the issue and determine the correct next steps.

Coordination of Benefits: Insurance companies routinely require patients to confirm that they have no other insurance coverage. If a patient fails to confirm with their health plan, it may result in a delay in payment or denial until the patient takes action. In order to correct this, the patient must contact the phone number located on the back of their insurance card and provide all relevant information to the health plan. Once that is complete, please email support@zayacare.com that this is completed and we can resubmit the claim for payment.