The purpose of a Denial Management Process is to investigate every unpaid claim, uncover a trend by one or several insurance carriers, and appeal the rejection appropriately as per the appeals process in the provider contract. Denial management is a critical element to healthy cash flow, and successful revenue cycle management. Healthcare organizations get paid to make people feel better, and not to run around dealing with insurance companies and tracking down why a claim is denied. Each patient is unique when it comes to the care you provide so each denied claim is also unique. We use a systematic, hands-on approach to ensure each claim receives the attention it needs to be resolved quickly, while also adhering to a strict systematic approach and defined best practices. This ensures maximum results and improved and efficient collections. Each claim is analyzed, researched, and prioritize claims based on payer, amount, age of bill, or other business rules to ensure maximum benefits.

The basic process of handling denials efficiently are:

  • Counting the number of denied claims
  • Identifying the cause of the denial
  • Creating a tracking/ reporting process to measure your performance over time

Our value proposition

  • Verifying registration issues – Insurance verification, patient information, and payer information
  • Charge entry validation
  • Developing a reporting system for use in owning analysis
  • Collect data that you can act upon in order to facilitate procedural improvements
  • Plan in advance with pre-authorization

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