Field-tested Techniques That Get Claims Paid

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DENIAL MANAGEMENT

Adopting a proactive claim denial management system includes tracking denial statistics, using automated processes for updating payer rules and codes, identifying and preventing avoidable errors, and focusing on submitting cleaner claims rather than appealing claims.

Why claims are denied:

  • Missing information, such as absent or incorrect patient demographic data and technical errors
  • Duplicate claim submission
  • Service already adjudicated
  • Services not covered by payer
  • Time limit for claim submission already passed

iMetrix Health Solutions denial management process uncovers and resolves the problems leading to denials to shorten the accounts receivables cycle. The denial management team establishes a trend between individual payer codes and common denial reason codes. This trend tracking helps to reveal billing, registration and medical coding process weaknesses that are then corrected to reduce future denials, thus ensuring first submission acceptance of claims. Also, the payment patterns from various payers are analyzed for setting up a mechanism to alert when a deviation from the normal trend is seen.

WHAT OUR TEAM DOES:

  • Navigate the complexities of the insurance system

  • Flag potential denial-causing errors

  • Lessen the number of denials

  • Complete claim denials within a week

  • Track denials by payer, type of denial, and provider to identify trends

  • Amend policies and procedures to avoid denials