Denial

Denial management is a vital component of revenue cycle management in medical billing process. Denial Management is to investigate every unpaid claim and appeal the rejected claims appropriately. It demands extensive knowledge and timely execution. ABCLLC have a well-experienced team of denial professional trained to identify the root cause of expensive denials. Our dedicated and skilled denial professionals can handle denial efficiently and in a timely manner to minimize denials reimbursements. ABCLLC  correct and resubmit the claims and file an appeal towards deemed medically not necessary claims. The appeal letter is sent to retreat the payer for their mistakes and make them clarify why the original processing of the claim was incorrect. Systematic tracking of denials will collect data back to the billing process to prevent future denials of the same nature, thus ensuring first submission acceptance and payment of claims. Denial Management team helps you to take control of your denials and accelerate reimbursements.

Denials occur because of 

  • Inaccurate or Incomplete Insurance information
  • Absence of Pre-Authorization number
  • Filing claims after the allowed time frame
  • Credentialing and non-enrollment errors of the provider
  • Medically necessity of patient

What we do:

  • Examining the volume of denials and analyse
  • Reckon denials not meeting the deadlines and claim age
  • Statistically estimating denials based on payers, CPT codes and ICD 10 standards/HIPAA regulations
  • Grouping the denials by coding and CPT/HCPCS 
  • Preparation of a comprehensive denial management report
  • Systematic approach of tracking and managing claims denials.
  • ABCLLC will reduce denial backlogs and apply best practices to reduce denials overtime
  • We work with payers to discuss, revise or eliminate contract requirements that lead to denials and appeal
  • Prevent future claims denial by reconciling missing patient information with existing records
  • Denied claims are appealed to reverse the payer decision such as fee schedule, no pre-authorization & pre-cert (extenuating circumstances), filing time limit, Medically necessity denial, etc
  • Focus on appealing claims that bring the highest amount of revenue than the provider adjustment.
  • Claims-related Alerts activation to inform particular denials.
  • Creating awareness to the client by sharing unpaid denial issues.

Denial comparison with others

Denial ABC LLC Others

All denied claims are followed up in 8 hours

Yes

May be

Specific denied claims are researched and analyzed
for the best solution

Yes

May be

Prioritizing denials and evaluating them to appeal

Yes

No

Denied claims are appealed to reverse the insurance decision
such as Bundling, no pre-authorization & pre-cert (extenuating circumstances),
timely filing limit, Medically necessity etc

Yes

No

Appeal letters are sent along with supporting documents like DOR
(Designation of representative form) with patient's signature,
WOL (Waiver of Liability) form, Provider Complaint form, Dispute form,
Reconsideration form, AOB form and W9 form according to insurance guidelines.

Yes

No

All appealed claim are followed up by every day

Yes

No

If there is no response for the claims submitted in 30 days
"No payment" appeal sent to insurance

Yes

No

Verbal appeals were made by calling for denied claims.

Yes

No

Alerts are created for the front office regarding denial such
as out of state Medicaid, COB update and Medicaid yearly
office visit exceeded.

Yes

No

Claim denial inquiry are done by live chat and secure
message on insurance portal

Yes

May be

Frequent communication to the provider to avoid future denials

Yes

No

Educating the practice employees to obtain prior authorization
for more office visits when the patient exceeds the office visit
for the year.

Yes

No

If the insurance deny the claims for LCD and NCD guidelines
for medical necessity, the provider is educated to use high
specificity diagnosis.

Yes

May be

Informing the patient to update COB with the insurance.

Yes

May be

Monthly insurance reversal report Emailed to the practice.

Yes

No

Future denials are avoided by analyzing insurance guidelines such as
LCD, NCD, CPB .. etc.

Yes

May be

ADDRESS

  • 5 Concourse Pkwy Suite 3000 Atlanta, GA. 30328
  • Phone: 833 368 7772
  • Fax: 404 600 1099
  • Email: info@applebcredentialing.com
  • www.applebcredentialing.com

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