Five Whys a Denial Pattern
Use Five Whys to find a process root cause behind repeat claim denials.
Eight claims denied for missing referring provider information. Five Whys moves from visible error to controllable process cause Stopping at "front desk forgot" creates blame but leaves the intake and billing system unchanged. Why 1 Why were the claims denied? The referring provider field was blank. Start with the specific defect, not the person. Why 2 Why was the field blank? The intake screen allowed staff to continue without it. The cause moves from memory to system design. Why 3 Why did staff not know this payer required it? The rule was kept in an informal sticky note by billing.…
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