Denials Management

Healtheq offers a full suite of healthcare denial management services that include A/R follow-ups, claim status checks, resolution of denied claims, preparing appeal letters, etc. – all done with one goal in mind, which is to collect revenue due for medical billing services rendered.

It is important to note that terms, claim denial and claim rejection, are often used interchangeably by office billing personnel as both may be considered a part of the denial management process. Rejected claims will not be processed as they have not been received/accepted by the payer. Therefore, these claims do not make it into the adjudication system. This simply means that a rejected claim must be submitted when the errors are corrected. Often times, this causes a reduction in cash flow because no one is looking at system-rejected reports or it is believed that they will receive a denial EOB. Is your staff looking for resolving rejected claims sent to the payer via either electronic data interchange (EDI) or paper? A denied claim has been received by the payer and has been adjudicated and payment determination has already been processed. A denied claim has been determined by the insurance company to be unpayable. Denied claims represent unpaid services and lost or delayed revenue to your practice. Does your practice execute a denial-management-strategy process?

Due to lack of time and expert knowledge on the healthcare denial management reimbursement domain, many physicians and facilities fail to manage denied claims and resubmit them. Denial Managements require expert knowledge and timely execution. Therefore, only dedicated and skilled professionals can handle them efficiently, successfully and timely. HealthTeq deploys a dedicated team of employees who will manage denials promptly and provide efficient denial management services. These experts analyze the possible denial trends and also initiate ‘global action’ that can impact many claims with a simple fix to prevent repetition of the same denials. Our team of healthcare denial management experts track denials, identify root causes and execute denial management prevention strategies. Additionally, it is important to provide feedback to appropriate internal department personnel and physicians on denial management trends and findings. Medical practices which lack a focused strategy for denial management are most likely to see unfavorable results, as are often too common, left to sit and eventually written off as uncollectable.

HealthTeq has established a workflow that tracks claims as they enter and leave your system. HealthTeq does extensive groundwork to correct ambiguous claims and avoid the chances of them getting rejected again. To accomplish this task, they perform a thorough root-cause analysis, decide on the right solution for fixing the particular issue, take the corrective action and submit the claim for payment.