Denial Management & Appeals
Denial Management & Appeals
The process of Denial Management has only one key – ANALYSIS, once the root cause of denial is figured, correcting it and getting paid for it is not a task. The skill of a specialist is required to get the perfect analysis into a claim. It is one of the biggest nightmares for a healthcare organization. Most of the time, the main reason for denial is incorrect or missing data. We ensure that we chart every code according to the denial type and responsibility to arrive at a perfect denial resolution and our Agent’s are expert in Denial Management.
Our Agents resolve the denials by following the below process :
- Investigate the exact denial reason and see if it is a controllable or non controllable denials :
- We also educate practices on denials that can be controllable by updating correct demographic, adding correct CPT code, sending Medical records along with claims if that is the insurance requirements.
- Non-controllable denials include – COB not updated, requesting additional details from the patient, out of network provider, prior Auth required but not obtained etc.
- Focus on resolving the denials by following the end to end process
- Resubmit claim by correcting the error or send requested information
- Mail or FAX the appeal as necessary
- We also review the monthly denials to find any specific trend and work on reducing the denial %
