Denial Management Service - For Cleaner Claims & Quicker Reimbursements

A pro denial management service is the backbone of every healthcare practice. Hire us and let us take responsibility for all the denied claims for you!


What Is Denial Management Solution?

A denied claim is “the one that the payer has adjudicated and denied the payment” and denial management is the strategic procedure that is performed to find out and resolve all the problems that cause medical claim denials. In addition to that, a denial management solution also involves mitigating the risk of future denials making sure there are quicker reimbursements and a healthy cash flow.

Here are some facts that have been concluded from a recent Medical Billing Services case study:

➢Out of claimed patients, almost 6% to 8% are denied.
➢Write-offs constitute about 3% of the entire revenue.
➢Out of $3 trillion in health claims, $262 billion are denied initially
➢Among all the denied claims, 65% of them are never reversed.

What Are The Reasons Behind Denied Claims?

Before getting to the reasons for the denied claims, have a look at the two main types of denied claims:

•Soft Denial: As the name suggests, this is a temporary denial and is reimbursable after submitting a claim.
•Hard Denial: This is a permanent denial and cannot be subjected to reimbursement.

Here are the top reasons behind denied claims:

1.Cloning: If a claim is cloned or, in other words, duplicated, it is going to be rejected or denied. This often occurs as a result of human error or some error in the system.
2.Intangible Service: When an insurance plan does not cover a healthcare practice and make a claim against that, it leads to rejection or denial.
3.Passed Deadline: There is always a time limit to submit a claim and if you make a claim after the deadline has been passed, it will lead to denial straightaway.

Want to Put Everything on Our Shoulders

How Does Our Denial Management System Work?

Our denial management solution is a system focused on problem-solving. Our goal is to find out the setbacks in billing, registration and medical coding followed by corrective measures to prevent future denials.

This is the first step and a very crucial one. Our team of experts makes sure to reach the root cause of the reason for denial.

After the categorization of the claims, their respective departments collect and resubmit them for a claim again.

In this step, we come up with a checklist of all the denial reasons and ways to cope up with them.

Next step is categorization. In this step, we assign the claim to the designated team for corrective measures after identifying the reasons.

In this step, we perform regular follow-ups to track the status of the claims that were submitted.

After the preventive action, we run a second