Denial Management

We at Soliox Technologies understand that a good denial management process is not simply about working denials, it is about systematically gathering the data required to eliminate denials.

Our Denial management Process tracks every claim that has denied and can report this by payer, by CPT, by physician and by diagnosis. This information is presented in a manner that allows fast identification of trends. The data and analysis will allow many opportunities for process improvements and revenue enhancement for the practice.

Our powerful Denial Management Solution can optimize your medical billing and speed up your cash flow. As Denial management is a subsection to Accounts Receivables of any medical facility, we religiously follow the below methodology of managing denials from payers. Our solution is focused around the three key fundamentals to effective denial management

  • Prevention
  • Analysis
  • Tracking and Trend Management

Prevention

Prevention focuses on actions that can be taken upstream in the patient encounter to prevent denials from occurring in the first place. Prevention can be introduced anywhere in the patient encounter such as: Pre-admit/Pre- registration, Scheduling, Admit/Registration and Billing. Our denial management experts ensure that we track such trends and keep the Client informed periodically about improvements/process changes that can be made across functions.

Analysis

The process of analysing and aggregating similar denials is strategic in denial management. The Denial management team at Soliox Technologies understands that analysis and segregation is a forerunner to follow-up process and hence for us it is a fundamental step in denial management.

Tracking and Trend Management

Besides keeping a track of the denial trend from payers our experts also actively monitor the payment patterns from various payers and set-up a mechanism to alert when a deviation from the normal trend is seen. This is important in understanding the causes of claim denials and enhancing long-term efficiency and drastically reducing lost revenue.

Some of the Common Insurance Denials

  • Claim denied for Missing / Additional information
  • Claim denied as Duplicate
  • Claim denied for Prior-Authorization / Referral
  • Claim Denied as Inclusive/ Bundled. Global
  • Claim denied as not medically necessary / Pended for medical notes
  • Claim denied as non-covered service
  • Claim denied for eligibility
  • Claim denied for late filing
  • Claim denied as CPT - Dx mismatch
  • Claim denied for EOB from the primary insurance
  • Claim denied for referring physician info
  • Claim denied for COB
  • Claim denied for incorrect provider info
  • Claim denied for wrong diagnosis
  • Claim denied for modifier
  • Claim denied for pre-existing condition
  • Claim denied / pending for accident information: (Workmen's Compensation)

Key Functions of Denial Management

  • Maximize cash flow - Reporting identifies denial causes having the greatest financial impact, thereby accelerating cash flow.
  • Identify the root cause of denials - Collecting and interpreting denial patterns to quantify denial causes and their financial impact.
  • Support accurate workflow priorities and scheduling for follow up - Collecting information on denial appeals, including status, escalation, correspondence with payers, and the disposition of denial appeals to increase recovery amounts.
  • Provide accurate and timely statistics for Management / Clients - Providing management analysis reports and other information to prevent future denials.
  • Track, Prioritize & Appeal denials - Generating appeal letters based on federal and state statutes and case citations favouring the medical provider's appeal.

-Avoid out-of-timely filing.

-Analyse the effectiveness of denial resolutions.

-Identify business process improvements to avoid future denials.