Denial management
Denial Management, and Denial Prevention
We focus not only on resolving denials, but also on identifying recurring denial patterns and supporting corrective actions to reduce preventable revenue leakage. A denial worked and closed is one claim. A denial category traced back to the step that caused it is every claim after it.
What we handle
The resolution work and the prevention work, run together, because separating them is what lets the same denial come back.
- Denial identification from remittance and correspondence
- Denial categorization against reason and remark codes
- Root-cause analysis by category, payer and originating step
- Documentation review before rework
- Corrective action at the point in the cycle that caused it
- Claim correction
- Reconsideration support
- Appeal preparation support
- Appeal deadline tracking
- Resubmission
- Denial trend reporting
- Preventive action recommendations
- Write-off recommendation where the denial is not recoverable
- Feedback into registration, eligibility and charge entry
Your queues, your system, the same people on them every day.
How a denial is closed
The loop closes at prevent, not at resubmit. A denial that is only resubmitted has taught nobody anything.
- 01Identify
- 02Categorize
- 03Analyze
- 04Correct
- 05Resubmit
- 06Report
- 07Prevent
What you get
- Every denial coded to a category and a cause
- Not just the payer's reason code. Where in your cycle it originated, so the fix has somewhere to go.
- Corrective actions routed upstream
- A registration-caused denial becomes a registration change. We raise it with the evidence rather than reworking it forever.
- Appeal preparation, with the deadline tracked
- Documentation assembled to your template and the filing window tracked, so an appeal is never lost to a date.
- A trend report you can act on
- Categories ranked by volume and by value, with what changed since last month and what we recommend doing about it.
Reporting cadence
- Daily
- Denials identified, categorized and worked.
- Weekly
- Emerging categories, payer behaviour changes and appeal deadlines approaching.
- Monthly
- Denial trends by category, payer and cause, with corrective actions taken and recommended.
How it is measured
KPIs and SLAs are customized according to the client's process requirements and contractual scope.
These are the measures we report on. The targets against them belong in your agreement, where they can be negotiated and enforced, rather than on a web page where they cannot.
- Denial resolution turnaround
- Denial categorization accuracy
- Recurrence rate by category
- Overturn rate on appeals and reconsiderations
- Appeal deadline compliance
- Preventable denial volume over time
- Corrective actions raised and adopted
- Process compliance against the SOP
- SLA compliance
Work the denial once
Send us your top denial categories by volume and by value. We will come back with a resolution model, a prevention plan and a transition plan.