What is Denial Management in Healthcare?

Denial management is often confused with Rejection Management. Rejected Claims are claims that have not made it to the payer’s adjudication system on account of errors. The billers must correct and resubmit these claims. Denied Claims, on the other hand, are claims that a payer has adjudicated and denied the payment.
Healthcare organizations should be concerned about both rejected claims and denied claims. The claims rejection management process provides an understanding of the claim’s issues and an opportunity to correct the problems. Denied Claims represent lost revenue or delayed revenue (if the claim gets paid after appeals).

Our Denial Management Service Offering

To successfully appeal denied claims, the billers must perform a root-cause analysis, take actions to correct identified issues, and file an appeal with the payer. To thrive, a healthcare organization must continuously address the front-end processes to prevent denials from recurring in the future.

Prime Doc BIlling denial management team has seasoned professionals who

  • Investigate the reason for every denied claim
  • Focus on resolving the issue
  • Resubmit the request to the insurance company
  • File appeals where required

We analyzed your denied claims

Our experienced understand that each denial case is unique. We correct invalid or incorrect medical codes, provide supporting clinical documentation, appeal any prior authorization denials, and understand any genuine denial cases to pass the responsibility to patients, and follow-up effectively. We re-validate all clinical information before re-submission.
As an experienced medical billing company, we work with you to analyze your denied claims and reduce denial to 0% over time.