DENIALS & APPEAL MANAGEMENT
$6 per hour* onwards
Our Denials and Appeals Management service is designed to increase Revenue Collection for Physician offices.
Our expertise includes managing denials for following reasons:
- Authorization Issues
- Referral Issues
- Medical Necessity and Medical Records requests
- Non-Participation with Insurance Network
- Terminated Insurance
- Coordination of benefits
- Inclusive Procedures
- Partial Payments
- Out-of-network claim status and deductibles
- EDI Rejections
- Letter of Protection from Attorney cases
- No status and No claim on File
- Workers’ Compensation
- PIP cases
- Obtaining an accurate reflection of denials for a multispecialty practice can be challenging. The denial rate for a multispecialty group practice may be 5 percent, but that overall rate may include a 20 percent denial rate for obstetrics and a rate of 1 percent for family practice.
- You need to look at denial rates by type of specialty. We segregate denial rates for primary care [family practice and internal medicine] from those for specialties that have potentially higher denial rates.
- When the denial rate is high, it should be looked at immediately. We address two areas of denials: why they are occurring and preventing them in the first place.