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Denials Management

Denial management is all about bringing number of denials down to the lowest i.e. minimizing on losing out reimbursements and maximizing probability of payments of unpaid claims next time.

"DoctorsBackOffice" denial management system includes charge entry analysis, tracking of payer denials, and activation of claim alerts on claim resubmissions and status. Denied claims are resubmitted within a week not exceeding 21 days, as there is a specified time for re-submission. Tracking of denials is important to ensure that claims are not being denied for the same reasons, or expiring before resubmission.

Identifying the reason

We monitor reason for denial, it is the first step to getting paid successfully. Common claim denials include type, number and source of the denial, or coordination of benefits, documentation, bundled/non-covered procedures, credentialing, authorization, duplicates, referrals, medical necessity, charge entry, PIP applications, and details of accidents, pre-existing conditions, and incorrect demographics. The insurer usually mentions claims adjustment reason codes (CARC) for each CPT, and may be accompanied with remittance advice remark code (RARC). These claims are unpaid services and are either lost or delayed, revenues to physician's practice. Once identified, they must be analyzed and managed upon thoroughly.

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