Claim denials for negative pressure just keep growing

Monday, March 31, 2008

COLUMBIA, S.C. – Denials for negative pressure wound therapy increased during the fourth quarter, from 86% to 90% in Jurisdiction A. TriCenturion’s prepay review, released in February, found that 10% of claims were paid and 72% were denied. Of the denied claims, 4% were denied because no medical records were submitted for review; 96% were denied because they did not meet coverage criteria; and 18% of claims were denied for non-response. TriCenturion began reviewing claims in 2006 for new products added to the category. The review will continue, Tricenturion said.