The #1 Challenge of Denials Management

The largest challenge in denials management is accurate and fast identification and analysis of the denial. All subsequent processing can be enhanced at this stage.

Analysis consists of determining denial reasons and the actual dollar amount denied, capturing information printed on the denial EOB that may be useful for reporting or follow up, and possibly routing and preparation for further processing.

Accurate, thorough analysis requires close attention to detail and extensive experience with claims denials. At the same time, analysis must be completed as fast as possible without loss of quality in order to:

		Maximize cash flow with fast rebilling
		Support accurate workflow priorities and scheduling for follow up
		Provide accurate, timely statistics for management and executive reports
		Avoid out-of-timely filing

Quick release from analysis is important, but so is analysis quality.

A large amount of resources are required to overcome this challenge.  Doing so is critical to the proper identification, tracking, and reporting of denials.

Trained specialists must review a very large amount of paper in order to provide a detailed and complete picture of denials.   In addition to RA's and EOB's, large quantities of non-posted correspondence must be analyzed as well. Accurate statistics depend on careful calculation of amount denied and denial reasons.

Typical business office staff simply does not have the time to perform this in-depth review.
 
To meet the requirements in a cost effective manner requires carefully designed processes and tools, a sophisticated document imaging system, trained and experienced staff, and exceptional quality assurance resources.   

The ability to accurately identify and track denials requires much more than just technology.  This is what is done at our facility.

Healthcare Reports provides specialized staff and technology that makes it cost effective to overcome the hurdle of fast, yet accurate denials identification and tracking.