Denial Management Services
Denial management is often confused with Rejection Management. Rejected Claims are claims that have not made it to the payer’s adjudication system on account of errors. The billers must correct and resubmit these claims. Denied Claims, on the other hand, are claims that a payer has adjudicated and denied the payment.
Healthcare organizations should be concerned about both rejected claims and denied claims. The claims rejection management process provides an understanding of the claim’s issues and an opportunity to correct the problems. Denied Claims represent lost revenue or delayed revenue (if the claim gets paid after appeals).
To successfully appeal denied claims, the billers must perform a root-cause analysis, take actions to correct the identifies issues, and file an appeal with the payer. To thrive, a healthcare organization must continuously address the front-end processes’ problems to prevent denials from recurring in the future.
Clority Healthcare’ denial management team has seasoned professionals who:
- Investigate the reason for every denied claim
- Focus on resolving the issue
- Resubmit the request to the insurance company
- File appeals where required
We understand that each denial case is unique. We correct invalid or incorrect medical codes, provide supporting clinical documentation, appeal any prior authorization denials, understand any genuine denial cases to pass the responsibility to patients, and follow-up effectively. We re-validate all clinical information before re-submission.
As an extended billing office, we work with you to analyze your denied claims and reduce denial % over time.
FILING APPEALS
We analyze denial reasons, prepare appeal letters, and refile the claims by attaching clinical documentation and submit the claims via fax appeals in a payer-specific format.
REDUCE DENIALS THROUGH ANALYTICS
Different component processes within the revenue cycle chain can result in claim denials. Often, denial issues are practice-specific or facility-specific. We understand the trends in claim denials and launch an iterative process to reduce them based on specific causes.