Denial Management Services
What is Denial Management in Healthcare?
Confusion often arises between denial management and rejection management. Rejected claims occur when errors prevent them from reaching the payer’s adjudication system. Billers must fix and resubmit these claims. On the other hand, denied claims are those that have been processed by the payer but not approved for payment. Both rejected and denied claims are crucial for healthcare organizations to address. By effectively managing rejected claims, organizations can identify and resolve any problems, ensuring timely reimbursement. Denied claims, on the other hand, result in lost or delayed revenue, making it essential for billers to carefully analyze the root cause, take corrective actions, and file an appeal to maximize reimbursements.
Our Denial Management Service Offering
Soho Tech Services 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.
At our office, we recognize the individuality of every denial case. Our team is dedicated to resolving any errors in medical codes, supplying crucial clinical documentation, and pursuing appeals for any previously denied authorizations. We also take the time to understand genuine denials and ensure they are properly addressed with patients. Our thorough process includes careful verification of all clinical details before resubmission. As an extended billing office, we collaborate with you to thoroughly review denied claims and successfully decrease their overall percentage over time.
Filing appeals:
We meticulously examine the reasons for denials, craft persuasive appeal letters, and resubmit the claims with relevant clinical documentation using a payer-specific fax appeals process to ensure the best chance of success.
reduce denials through analytics:
Various processes within the revenue cycle chain can lead to denials of claims. These denials are often linked to a particular practice or facility. We are well-informed about the common reasons for claim denials and take proactive steps to continually mitigate them.
Track Status
Follow up with the insurance company to track the status of the claims.
Identify Denial Issues
We identified denied claims, to analyze the reasons, follow-up with insurance company to check if additional information is needed and address the issues.
Refile the claim
Refile the corrected claim to the insurance company and initiate follow up plan. At times we may need to bill the secondary insurer.
Resolve the Claim
Track the status of the claim with the insurer and follow-up till the claim is resolved. file Appeals as needed.
Benefits of the A/R and Denial Management Process with Soho Tech Services
Focus on getting claims resolved:
At the heart of our efforts lies the goal of not only obtaining claim status information, but also effectively addressing any issues with the claims themselves. Through improved utilization of web portals, we streamline the process of checking claim status, reducing the overall effort required.
Process Automation:
“Through our advancements in web portal adoption, we have streamlined the process of checking claims’ status, reducing the effort required.”
Workflow automation:
Our insurance company requires answers to specific questions for each claim status code in order to effectively resolve any issues. To streamline this process, we have implemented web-based workflow systems and carefully structured our claims follow-up work queues, resulting in improved documentation quality.
Dashboards and metrics:
We generate multi-variate reports to get a clear view of the A/R and focus our effort on the resolution.
Improving collections and reducing days in A/R:
Our clients see a minimum of 20% reduction in days in A/R and improved collections by about 5-7%.
We also provide A/R Follow Up Services. For more details, please visit our page.