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.
