What is Denial Management in Healthcare?

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.

Our Denial Management Service Offering

Adrotack 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 analyse your denied claims and reduce denial % over time.

FILING APPEALS

We analyse 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.