Understanding Denials

Medical necessity

One of the most common denials in behavioral healthcare is a medical necessity denial. These denials occur in almost every case of substance use treatment.  Carriers use medical based criteria to decide if a client's care can be authorized. If a client doesn't meet criteria, claims will be denied for lack o medical necessity. 

processing denIAls

Some denials are not the fault of the provider or submitting entity. Carriers often deny claims in error to delay payment. 


Unfortunately, not all billers complete their work in a timely and ethical manner. Plans typically give time frames to submit claims in. If these time frames are not met, appeals have to be filed. 


If a claim is denied, the provider or client has the opportunity to appeal the decision. These appeals take time to process, but they can be won if the correct procedures are followed. At AVA we differentiate ourselves by relentlessly pursuing payment on denials and appeals unlike other billing companies.