Why do my claims keep denying and what is the biggest cause?
Most denials trace back to simple mismatches: the client was not eligible on a date, the visit fell outside the authorization, a modifier or provider ID was wrong, EVV data was missing, or the claim was a duplicate. Fix the source data before billing, not after the denial.
Look at your last ten denials and sort them. You will likely see two or three repeat causes.
Georgia’s list of common denials groups them like this:
- Eligibility: not eligible on one or more dates, partial eligibility, or other insurance that should have been billed first.
- Procedure and modifier: a modifier that does not meet the billing rule, or a code not allowed on that date.
- Authorization: units used up, date outside the authorization, wrong provider ID, or an authorization number that did not cross over.
- Duplicates.
For personal care, add EVV: Georgia denies claims that do not carry EVV information.
A trade article also points to scheduling errors and caregivers not documenting daily living tasks before clocking out.
A simple fix routine:
- Verify eligibility every month.
- Check units left each week.
- Close every visit with a complete record.
- Review the remittance the day it arrives.
The cheapest denial to fix is the one that never goes out.
Sources
- Georgia Medicaid Common Denials webinar (Feb 2021) · Georgia DCH / GAMMIS
- Electronic Visit Verification (EVV): Provider-related FAQs · Georgia DCH
- So You Want to Bill Medicaid · Home Care magazine
Reviewed by Beth Bledsoe, Care Business Advisor®, 28 Oct 2026. Rules change. Confirm with your state Medicaid agency before you act.
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