Claims Denial Recovery and Management Program

You can counter the effects of declining payments and increasing cost pressures through effective claims management. Claims denial management is a critical component of a hospital’s revenue integrity and strategy. Claims Denial Management can enhance revenue at a time of declining payment.

Enhance Revenue Through Claims Recovery
Our clinical specialists review claims along with medical records for medical necessity. They identify the services rendered and validate that the appropriate levels of care are billed correctly. They address issues regarding documentation, lack of medical necessity and plan of care. Our staff will provide effective appeal letters to improve claims recovery. They provide complete follow-through on denials from 1st Level to 2nd Level to achieve the desired results. Furthermore, we provide comprehensive reports to assist prospective prevention.

Our Claims Denial Appeal Management Program
This program consists of parallel recovery and prevention processes:

• a claims recovery process to address claims that have been denied, and a
• prospective prevention process to avoid future claim denials.

Sample Review Findings