Commercial Claim Denial Management Automation

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Denials in claims management can cause problems across the revenue cycle. Understanding why they were denied, correcting them for submission to adjudication is a time-consuming process that involves several hours of manpower.

Manually managing denials is tedious and error-prone, claim denial management automation allows post-acute care teams to spend less time on a day-to-day basis with them. This prevents errors when it comes to claim submissions, ensuring smooth cash flow and reducing effort for staff on rectifying errors and reprocessing denied claims.

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Workflow description

Element5's denial management automation solution removes the need for care staff to perform all the manual processes required to rectify denied claims. Mitigating the trouble of all the tedious, repetitive documentation enables clinical staff to focus solely on patient safety and ensuring all their needs are met.

Monitor clearinghouse for new EOBs

Identify denied claims from EOBs

Import denials status, reason code to EHR

Redirect claim to staff for correction

The automation solution monitors clearinghouse(s) for newly posted EOBs, utilizing business process rules, it identifies all the denied claims from EOBs and imports them into the EHR along with the relevant details such as denial status, reason code, etc. Thereafter, the workflow triggers the redirection of these denied claims to the relevant staff for re-correction at the earliest possible time. This helps save hundreds of hours every week on the manual, repetitive task of scouring through the EOBs for denials and the subsequent reprocessing of denied claims.

Monitor Clearinghouse(s) for newly posted EOBs, Identify denied claims from EOBs on the posting date, and Import into EHR the denial status, reason code, and trigger workflow in EHR to route the claim to the appropriate staff for correction (all before the 835 is even available to download from the clearinghouse)

Benefits and ROI

  • Forget about denials and delays in claims management becoming bottlenecks to the revenue cycle
  • Reduce the burden of a huge load of tedious tasks and an inordinate amount of time required to identify and rectify denied claims
  • Reduce errors, improve error detection & rectification rates for denied claims, boosting the cash flow through timely reimbursements
  • Reduce the average handling time of denied claims by a huge margin through the simplification of an otherwise complex, time-intensive process
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Commercial Claim Denial Management Automation

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