Denial Management

Home Denial Management

Denial Management

In a word, denial management is a strategic technique that targets to unmask and resolve problems leading to medical claim denials. But that’s no longer all; the process must also mitigate the risk of future denials, making sure that practices get paid faster and enjoy a healthy money flow.

The denial management team is tasked with organizing a trend between recurring denial purpose codes and denial reason codes. The purpose is to point out the registration, billing, and medical coding setbacks through trend tracking and right them to prevent future denials. The team also analyzes the payment patterns for individual payers so that it turns into effortless to realize a diversion from the ordinary trend.

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Types of Claim Denials

Though all denials result in your physician exercise losing out on cash you’re owed, they exceptionally fall under five main categories

Clinical Denial

Administrative Denial

Claim Rejections

A clean claim is one that is submitted without any errors or different issues, together with incomplete documentation that delays timely payment. It additionally meets all the following requirements

Identifies the health professional, health facility, home health care provider, or durable medical equipment provider who provided service sufficiently to verify, if necessary, affiliation status and consists of any identifying numbers

Contains information sufficient to set up that prior authorization used to be obtained for sure patient services where prior authorization is required

Properly identifies the patient and health plan subscriber

Lists the date and region of service

If necessary, establishes the medical necessity and appropriateness of the service provided

Identifies the service provided by selecting a commonly accepted procedure or service coding system