Denials Management

According to a recent study by the Health Insurance Association of America, 14% of all claims submitted to payers are denied - that is one in seven that need rework, resubmission, and possible appeal by the provider. The same study found that six percent of EDI claims are rejected even before entering the payer's claim system, and these are not even counted as denials.

Typically only half of all first denials are ever appealed. Studies show that 45 percent of all first denial appeals are won. 50 percent of second denial appeals and 10 percent of third denial appeals are won

Medical Coding Audits

• Reduce the quantity of denied claims
• Receive fewer claim errors
• Identify and eliminate common mistakes
• Examine the top reasons for denial
• Develop a process improvement plan
• Implement methods to prevent common denials