Denial Management

Denial management helps us increase your payment velocity by giving us the tools needed to individually resolve, as well as, address the root cause of your denials and rejections. We automatically flag denials that require review which allows us to efficiently resolve denials and resubmit insurance claims quickly. By systematically rooting out your denials and examining the causes, you'll get paid faster and improve your bottom line.

Why are my claims being rejected or denied?

Even though our system makes it easy to identify and resolve specific denials and rejections, our proactive approach looks at the root causes so we can work together to eliminate denials and rejection in the first place. We'll provide you with report-based feedback that groups your denials and rejections by reason and dollar amount, trended over time.

This helps you identify frequently recurring denials and rejections that can be addressed through process changes in your practice. For example, if you have routinely received denials due to patient eligibility, we will suggest corrective actions to take in order to identify such patients before they are seen by the physician.

Flag Denials and Rejections Automatically

Once we submit your electronic claims, our integrated clearinghouse checks the format of your electronic claims for any missing information and validates your electronic claims against various payer-specific formatting requirements. If there are any problems with your electronic claims, we will receive a claim processing report that provides a list of rejections that must be resolved before your claims can be forwarded on to the government payer or commercial insurance company. Our system will automatically categorize your rejected claims for correction and resubmission.

After your electronic claims are forwarded on to the government or commercial insurance company, they will be reviewed and adjudicated for payment by the payer. Because we are also enrolled for electronic remittance advice services, we will then receive an electronic remittance advice report back from the payer that provides details about payments and any denials. Those denials may occur for various reasons, such as the patient lacks insurance coverage for certain medical services, or the services were not deemed medically necessary. Any time we receive a denial, the status of that particular claim will be changed to "Denied", and as a result, your denied claims will be queued for correction and resubmission.

Resolve Denials and Rejections Efficiently

Since your insurance claims will be categorized as "Rejected" or "Denied," they are easily organized into our work list for claims needing follow-up action. For each rejection or denial, we will be able to see information about the insurance claims and a rejection or denial message. Your account manager will then take the appropriate course of action - this could involve follow-up with your front office staff or directly with the patient - to correct and resubmit the claim.