Denials Management

Our Denial Management services helps resolve complex and time consuming payers issues. Our highly vigilant Denials team provides detailed analysis and insight into every single denied claim.

All denied claims are identified directly from the EOBs and duly tagged according to the reason for their denial. In essence all denials are extrapolated from the other outstanding claims in the system in order to take a directed approach in resolving them.

Denied claims is a major feedback mechanism and we proactively and cautiously study what can be corrected internally to prevent rather than correct such denials in future. Our quality assurance takes coherent steps to tune up future work-flow.

The other methodology is deployment of a dedicated Denials resolutions team. It is set aside to fix all denials and resend them prior to their timely filing limit. In addition all denied claims requiring telephone correspondence with patients are done with an evening customer service team. Proactive efforts are taken to resolve claim denials to prevent sending patient statements which are routinely ignored and/or discarded. We resubmit corrected claims, submit medical records to justify medical necessity and track outcomes of the denials.

 Denial Reasons Abbreviations Count
 Inclusive procedure or service INCL 4
 Policy coverage Terminated TERM 2
 Non-covered services or charges NON-COV 12
 Incorrect or Missing provider id PROV-ID 1
 Provider not eligible to perform service PROV-NOT ELI 6
 Timely filing TFL 1
 Demographics updation required DEMO 5
 Co-ordination of Benefits COB 1
 No Authorization NO-AUTH 2
 Not Member's PCP PCP 1
 Invalid ICD/CPT ICD/CPT 2
 Patient gender not matching GENDER 1
 Denied for docs not submitted DOCS 2