Our Denial Management Process

• Identify Denials

  Our team identifies claim denials through reports, denial management software and payer remittance advice.

• Categorize Denials

  Next, we classify denials based on common reasons, such as missing documentation, coding errors, etc.

• Review Denial Details

  We analyze denial codes, denial reasons, and payer requirements provided in the remittance advice or denial notification.

• Gather Additional Information

  Our team gathers missing or required documentation, such as medical records, supporting documentation, or prior authorizations, to address denial reasons.

• Appeal Preparation

  We next prepare the necessary appeal documents, addressing the denial reason, supporting documentation, corrected claim information, and payer-specific forms.

• Submit Appeal

  Finally, we submit the appeal to the appropriate payer within the designated timeframe, adhering to the specific appeal submission guidelines and requirements.

• Track and Follow-up

  Our team monitors the status of the appeal and ensures timely follow-up with the payer, providing any requested information or documentation.

• Escalate (If Needed)

  If the appeal still gets denied or is not resolved satisfactorily, we escalate the case within the hospital, following established procedures.

• Generate Reports

  Our team also analyzes denial trends, identifies root causes, and generates reports to give you insights into process improvements for preventing denials.