u/GPSolutionsUSA

We’ve been analyzing pediatric OT/ST denial workflows recently and one thing that surprised me is how many denials are actually administrative/workflow failures rather than true medical necessity disputes.

A lot of the recurring patterns we’re seeing:

- authorization linkage mismatches

- CO16/M76 missing-info denials

- diagnosis-to-CPT mismatches

- duplicate/bundling confusion

- timely filing documentation gaps

What’s interesting is that many of these claims may still be clinically appropriate, but the operational failure upstream turns them into revenue leakage downstream.

Curious:

For people working pediatric therapy billing or backend A/R, what denial category eats the MOST time operationally right now?