March 30, 2026
Understanding the gap between clinical necessity and insurance coverage — and how your billing team can help close it. The Test Was Right. The Claim Was Denied. You ordered a molecular diagnostic test because culture alone wasn’t giving you the answer you needed. The clinical rationale was sound. The result informed your treatment plan. And then the claim came back denied. This scenario is more common than it should be — and it rarely has anything to do with whether the test was medically necessary. More often, the denial stems from a mismatch between how the encounter was documented and […]