---

Denial Automation

Many healthcare organizations rely on manual methodologies to manage and prevent denials. However, the partial automation of processes plays a significant role in mitigating costs and improving operational efficiencies. An average person spends about 18 minutes to sift through medical records to find the exact information needed, while it takes less than two seconds through automated solutions. Analytics and AI-powered solutions relieve your staff from timeintensive administrative tasks, helping them better focus on high-risk accounts and other highpriority activities.

Unlocking Potential by Automating Low-impact, High-volume Denials

Automation can transform your denial management process in significant ways.

• Eliminate duplicate denials when denial and payment is received on the same day
• Prevent denials due to non-coverage by identifying them at the first instance
• Automatically transferring account balances to the right person

An Efficient Automated Denial Management Framework

A well-organized denial management team establishes a strategic workflow by integrating analytics and automation solutions to prevent denials.

• Comprehend the Denial Framework. Root cause analysis tools including matched claim and remit are implemented to understand the denial patterns and identify the nuances of the common denial reasons.
• Gather Denial Appeals Information. The denial management service team collects critical data on denial appeals to determine the core issues. A predictive report is also established on the outcome of the denial appeals process.
• Real-time Reports. AI and analytics-driven insights are integrated to generate real-time, accurate reports that provide actionable insights to the management. These insights help take proactive measures to manage denials effectively.
• Track Progress of Denials Appeals. Automated appeals populate customized appeal letters in batches to facilitate reimbursements. File appeals are also done within a week of denial to ensure timely and accurate reimbursements.
• Segmenting the Denials. Denials in medical billing happens for various reasons. The medical billing service team leverages automation capabilities to organize and prioritize efforts based on value, effort and propensity of payment.
• Restructure Workflows. The denial management service experts map denials with specific categories as per Physicians, Payers, CPT codes etc. Once the denial patterns are mapped to the denial numbers, they strategize new process improvements to proactively address future concerns.

To learn more about how denial automation can help your healthcare organization accelerate the revenue cycle performance,
give us a shout!