We have been delivering denial management services since 2000. We provide customized services tailored to unmask and resolve problems leading to medical claim denials. Whether you need assistance with identifying and addressing the root causes of your denials, help with filing appeals and resubmitting claims, or claim rejection analysis, we've got you covered. Our services include denial analysis and identification of root causes, claims resubmission and appeals management, coding and billing audit of denied claims, coordination with insurance companies and payers, training, and education on denial prevention and management, and development and implementation of denial management strategies.
We use the latest technology and industry best practices to deliver high-quality services to improve your bottom line. Our goal is to help you reduce denials, increase revenue, and improve your financial health. We also help you mitigate the risk of future denials, ensuring that your medical practices get paid faster and enjoy a positive cash flow. In addition, our services identify areas that could be improved and prevent denials by educating, communicating, verifying insurance at prior stages, knowing the payers, accurate documentation, and from past mistakes.
Our Denial Management Process
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Identify Denials
Our team identifies claim denials through reports, denial management software and payer remittance advice.
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Categorize Denials
Next, we classify denials based on common reasons, such as missing documentation, coding errors, etc.
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Review Denial Details
We analyze denial codes, denial reasons, and payer requirements provided in the remittance advice or denial notification.
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Gather Additional Information
Our team gathers missing or required documentation, such as medical records, supporting documentation, or prior authorizations, to address denial reasons.
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Appeal Preparation
We next prepare the necessary appeal documents, addressing the denial reason, supporting documentation, corrected claim information, and payer-specific forms.
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Submit Appeal
Finally, we submit the appeal to the appropriate payer within the designated timeframe, adhering to the specific appeal submission guidelines and requirements.
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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.
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Escalate (If Needed)
If the appeal still gets denied or is not resolved satisfactorily, we escalate the case within the hospital, following established procedures.
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Generate Reports
Our team also analyzes denial trends, identifies root causes, and generates reports to give you insights into process improvements for preventing denials.
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