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Denial Management Services

Medical Claim Denial Management Process: 6 Key Considerations and FAQs

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This approach has helped us identify some of the key considerations around denial management. In this blog, we’ve selected the most common FAQs of denial management teams across hospitals and medical Practices, and how best they can be addressed.

In our 4Clover Approach to Denials Management, our team of strategists and technologists have designed a unique four-step strategy for effective denial management in healthcare—to reduce denials, while fostering timely and accurate reimbursements. This approach has helped us identify some of the key considerations around denial management. In this blog, we’ve selected the most common FAQs of denial management teams across hospitals and medical Practices, and how best they can be addressed.Let’s dive in.

Key questions
Denial Management Process
There are multiple ways to track and monitor the claim status after submission. As a first step, you can track your claim status online—a post in which, if an issue is identified, the Payer can be contacted over the phone for further clarifications on the claim status. If the issue persists and cannot be sorted by the customer support team, you can have a written enquiry to further support your case.
Unfortunately, most of the Payers don’t have the most up-to-date information on patient benefits. Data could be outdated as most oftentimes, some of the latest changes to the patient benefits are not yet updated. An automated and streamlined approach to prior authorization and eligibility verification is a simple way to mitigate the risks of claim denials.
Duplicate claims are amongst the primary reasons for claim denials, the topmost reason being eligibility denials. Moreover, each Payer has a different set of guidelines, and it’s best that your billing management team follows the guidelines outlined by the specific Payer on claim resubmissions, in order to prevent the common patterns of claim denials occurring due to duplicate claims.
The turnaround time for Accounts Receivables varies with Payers and it may be overwhelming at times to keep track of the differing timelines. AR follow-up can therefore ideally be done between four and five days post the expected time of payment.
In the world of value-based reimbursements and care, Hospitals and Practices are architecting new strategies to drive engagement and provide positive patient financial experiences. It is critical that care providers adopt automation and analytics strategies to improve price transparencies, give them a heads up on patient financial responsibilities for self-pay patients, to drive actionable insights that allow them to make informed financial decisions, in terms of care. This can significantly improve patient collection, while enhancing Patient experiences. Also Read: 8 Ways to Optimize Patient Payment Collections and Increase Practice Revenues
If you feel that there are constant and multiple instances where you are asked to provide medical records, you can have the issue addressed by discussing it with your Payer representative, followed by a letter when needed. If the issue persists, you can contact a higher official regarding the issue and have written correspondence to support your case

Claim denials could make or break your revenue cycle. Here’s how you can identify the root cause of your Claim Denials

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SolvEdge’s Denial Management Services

Spending More Time Managing Denials & Worrying about Getting Paid, and Less Time on Creating Amazing Patient Experiences?

We’ve Got You Covered!

At SolvEdge, our denial management programs and prevention strategies are uniquely designed to reduce the spiking denial rates, while having a proactive approach to denial prevention. Our customized workflows help determine the root cause of denials. Once the denial patterns are identified, we create a detailed report that evaluates the recurring causes of claim denials under various categorizations like the Payer, doctor, diagnosis and CPT codes. By leveraging these insights, we implement process improvements to reduce denials and optimize revenues.

SolvEdge’s uniquely designed 4Clover program for denial management is a time-tested and proven approach (with the phases—1. Analyze, 2. Strategize, 3. Discover & 4. Implement) that ensures maximized revenues and collection of every dollar due!

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To learn more on how SolvEdge’s denial management services can help improve your collections percentage, Give us a Shout!

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SolvEdge Simplifying Healthcare Experiences

From our humble beginnings as a healthcare start-up—to becoming a full-blown healthcare-exclusive digital transformation provider, our journey has been quite a remarkable one. Today, SolvEdge is a leading-edge Healthcare services and solutions provider—trusted by 450+ Hospitals, 3500+ Physicians and millions of patients across the globe.

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