With so many patients to encounter, handling claims in-house often becomes a headache. You must pay attention to details while creating and submitting a medical claim and ensure timely and accurate reimbursements. Even a small mistake in code selection, documentation, or provider detail may lead to payment delays and denials, impacting your facility’s financial health. At the end of the day, the cash must roll in to help you keep your practice’s doors open.
Yes, we know the struggle! Thus, this guide will discuss denial code B7 in detail, including what causes it, some preventive strategies, and steps to address it. So, without stalling, let’s dive into the details!
B7 Denial Code – Description
This denial code identifies that the billing healthcare practitioner is not eligible or certified to receive reimbursement against a specific rendered procedure due to invalid, incomplete, or missing credentialing data.
Common Causes of Denial Code B7
Discussed below are some of the scenarios or causes that may lead to denial code B7:
Incorrect Provider Details
If the billing physician’s number has an error, i.e., it comprises special characters instead of just alphanumeric characters, it will result in claim denial.
For example, the provider identification number (PIN) field on the claim of the billing clinician may have been left blank. Also, if the provider rendered service before the certification date, it may lead to a denial code B7.
Specialty Mismatch
You may receive this denial when the rendered procedure or service does not align with your specialty.
For instance, you may receive denial code B7 while reporting diabetes outpatient self-management training related codes G0108 and G0109 if your A/R 52 – education recognition program (ERP) certification is missing on the provider file.
Physician Enrollment Status
You will receive this denial if the physician enrollment file contains any of these A/R codes; retired (31), moved out of state (32), suspended because of Social Security Administration (SSA) review (36), suspended due to unassigned Pay Medicare (37), deceased (38), resigned (39), new group with pending Medicare B approval and profile transfer (42), unapproved group for Medicare B (43), inactive PE enrollment status (46), or when the provider has not billed Medicare for 12 consecutive months.
Besides, you may receive it because the date of service on the claim is before the practitioner’s Medicare Effective Date. For instance, if you are an independent diagnostic testing facility provider, you can report rendered services only on your updated Provider Enrollment Application. If this application is not set up, it will result in a B7 denial code.
Non-Covered Services
If you are billing for services that are not covered in the patient’s insurance plan, this may also cause the denial. It can happen because of specific guidelines, limitations, or policy exclusions set forth by the insurance company.
How to Prevent Denial Code B7?
Are you tired of getting the B7 denial code? Is it constantly taking a toll on your practice’s revenue cycle? Discussed below are some mitigation strategies to help you avoid its occurrence:
Verify Provider Enrollment and Certification
Your first preventive strategy should ensure that the healthcare practitioner is eligible to render a specific procedure on the date of service. You can do it by ensuring there is no specialty mismatch, the date of service is after the certification came into effect, and the provider enrollment status is active.
Besides, you should train your team to update the ledger on all provider details, including certifications and credentials, to mitigate the risk of triggering denial code B7.
Ensure Claim and Documentation Accuracy
Ensure the claim is error-free and the documentation is complete to avoid getting a B7 denial code. Double-check the medical claim to ensure all entered data is up-to-date and accurate, including the billing physician’s name, NPI number, specialty, and address. Do not forget to document the practitioner’s specific certifications for the rendered service.
Moreover, you should submit claims on time to mitigate the occurrence of this denial. Unnecessarily delaying claim submission will increase the likelihood of issues related to the billing provider’s certification or enrollment status.
Maintain Effective Communication
Communication often works like a missing piece when it comes to handling claims. It can prevent you from several types of claim denials, not just the B7 denial code. Thus, we recommend establishing effective communication channels between the coding and billing team, healthcare providers, and insurance payers.
It will help you stay updated when there are any changes in provider certification and enrollment details. Besides, communicating with the payers will enable you to stay current on any updates in the insurance companies’ policies and guidelines.
Conduct Regular Internal Audits
Carry out regular internal audits to identify gaps in your coding, billing, and documentation workflow. It will help you identify denial code B7 trends when you review the past data. You can take preventive measures and implement tailored strategies to streamline your billing process and ensure a healthier revenue cycle.
How to Resolve Denial Code B7?
The preventive strategies we discussed above will help you steer clear of the B7 denial code. However, if you still get it, the following steps may help you in its successful resolution:
- Your first step should be to review the documentation carefully. Check the billing provider’s certification details to ensure the rendered procedure aligns with his specialty and is eligible for reimbursement.
- While checking the documentation, do not forget to verify the date of service. If it is after the certification’s effective date, then you are good to move forward.
- Next, double-check the provider’s credentials. It may involve contacting the billing physician to verify eligibility and required certifications for the rendered service.
- If you find any errors or discrepancies in the practitioner’s eligibility status or certification, we recommend identifying the root cause. It may involve conducting an audit to review your billing workflow or communication breakdowns.
- In case errors in claims were identified in previous steps, it is time to correct them and resubmit the claim. It may involve reaching out to the payer to facilitate supporting documentation or additional information submission.
- Monitor the claim status and follow up to ensure timely resolution of denial code B7. We advise keeping a record of all the communication to avoid issues later.
Bottom Line
Here’s a quick walk-through of what we discussed in this guide! We explained what the denial code B7 truly indicates, i.e., the provider’s ineligibility to receive payment due to invalid, missing, or incomplete credentialing data. Besides, we discussed some causes that may lead to this denial code, including specialty mismatch, inactive provider enrollment status, errors in provider details, and billing non-covered services. Moreover, we shared preventive strategies to help you reduce the likelihood of receiving this denial code. These strategies include establishing open communication lines, conducting regular internal audits, ensuring claim accuracy, and verifying provider certification and enrollment details. We also provided a step-by-step guide to resolve the B7 denial code. However, if you still find it challenging, you may outsource denial management services to professionals like MediBill MD.
