Denial Recovery
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Denial Recovery
Wage inflation, rising costs, lagging patient and service volume, and pandemic-driven uncertainty continue to put enormous pressure on healthcare organizations’ bottom lines—a situation exacerbated by unresolved claims denials representing an average annual loss of $5 million for hospitals representing up to 5 percent of net patient revenue
The good news is that denial does not automatically relegate claims to the write-off bin. In fact, as many as two-thirds of rejected claims are recoverable.8 Success—and lower recovery costs—requires a strategic approach designed to ensure the process aligns with payer requirements.
Additional information
Automations will pull medical records, consent forms, primary EOB, Invoices, etc. The automation will complete templated appeal letters, reconsideration forms, redeterminations and will upload to payor portals, e-fax, or save the appeal package into a shared drive location to auto-print over night collated by payer address for easy mailing in the morning depending on your payer access.
Coding/Billing
The intelligent automation can add modifiers, NPIs, CLIA, Change POS or work rejected claims in the clearing house based on rules.
Eligibility/COB
The intelligent process automation will navigate to the payor portal and check MBI/Eligibility, and other payer information and make corrections to patient name, DOB, policy or plan mismatch if it exists at the payer level to resubmit the claim for reimbursement.
Authorization Denials
