Claim Denials Reduction and Prevention

Nothing is more frustrating – or costly – than battling payers over denied claims. The good news is that a great deal of that frustration and financial damage is avoidable. Now you can reduce or even prevent costly and frustrating claim denials.

Introducing the Health e Practices Claim Denials Reduction and Prevention Program.

Part 1: Denied claims data analysis

In our RCM Power Team or RCM Power Team+ programs, we use or unique Claims Data Management platform and dashboard (powered by H4-Technology) to analyze your denied 837 and 835 claims transaction sets – historically as well as on a claim-by-claim basis – to determine common characteristics that contribute to the denial. Contributing factors may include:

coding errors
missing, incomplete or inaccurate patient demographic data
no pre-certification or authorization
insufficient medical necessity
timeliness/tardiness of claim submission
failure to respond to
out-of-network provider
policy cancellation for the patient
claims approval criteria/guidelines by payer

Part 2: Denied claims cleanup, resubmission and follow-up

Based on the denied claims data analysis, we conduct cleanup on denied claims that can still qualify for payment based on aging. We then resubmit the clean claim, monitor payment and follow up as needed with payers to ensure payment of valid, resubmitted claims.

Simultaneously, we develop an updated set of claim preparation protocols and make sure that all future claims are clean, accurate, timely, error-free and optimized for timely reimbursement. We also continue to monitor and follow up on aging claims that are overdue for payment.

Call 877-394-2750 now to speak to one of our Claim Denials consultants!

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