Warning your clearing house could have a problem…
If you’ve ever had claims denied and couldn’t figure out why, you’re not alone. Many billers assume claim rejections are caused by coding or modifier errors, but sometimes, the problem isn’t with you at all.
Recently, we ran into a situation that perfectly illustrates this hidden issue , and it’s one every biller and provider should know about.
The Problem: Claims Kept Getting Rejected
Back in March of 2025, one of our telehealth accounts kept getting claim rejections. The biller went through every detail — modifiers, CPT codes, taxonomy — and resubmitted several times. Still no luck.
It wasn’t until she contacted the clearinghouse that we found the real culprit:
Even though the taxonomy code was visible and correct on every claim, their system wasn’t recognizing it, meaning the claims were being rejected before they ever reached the insurance company.
The Fix: Clearinghouse Error Identified and Resolved
After several conversations, the clearinghouse admitted the issue was on their end. Months later, they rolled out a fix.
She had the provider re-sign the notes, resubmitted all the claims… and last week, we finally got paid.
What You Can Learn From This
Here’s what we took away from the experience, and what you can apply right now:
Always check with your clearinghouse if claims keep bouncing back for the same reason.
Don’t assume it’s a coding issue — sometimes, it’s a system-level glitch.
Document everything — dates, emails, claim numbers. You’ll need that paper trail if there’s a delay in payment.
Stay persistent — once the issue is resolved, reprocess those claims. You deserve to get paid for your work.
Final Thoughts
Claim denials can be stressful, but they’re often preventable once you know where to look. Your clearinghouse plays a major role in whether claims even reach insurance, so make sure you’re checking both sides of the process.
If you found this story helpful, share it with other billers and providers. Sometimes, it’s not us, it’s the system.
