Denial Management Module

For Denials makes the task of handling denied claims manageable by deploying a comprehensive denial database and tracking system.

The comprehensive system is comprised of reasons for denial; denial appeal status; provider and payer responses to authorizations and concurrent denials; physicians and departments involved in the denial process; case-management notes; level of care determinations; and revenue lost or at risk. The database and tracking system was designed to have a tangible impact on organizational performance.

The module help with denials by focusing on the causes as well as tracking the impact on your organization before and after detection.

With MDCare denial management for Denials you can:

  • Maximize cash flow
  • Identify the root cause of denials
  • Support accurate workflow priorities and scheduling for follow up
  • Provide accurate and timely statistics for executives
  • Track and prioritize denials
  • Avoid out-of-timely filing
  • Analyze the effectiveness of denial resolutions
  • Identify business process improvements to avoid future denials
  • Information Capture: 100% of A/R data is captured and scrubbed to validate all transactions including payments, adjustments, reason/remark codes, co-pays, co-insurance, deductibles, and allowed amounts. A rules based interface consistently posts accurate data for efficient follow-up and reporting.
  • System Integration. Reduce disparate departmental information systems and seamlessly share and access revenue cycle data across a common platform.
  • Workflow Automation. Dynamic worklisting and rules-based automation emulates human activity to create standard and repeatable processes and procedures in areas such as eligibility verification, denial management, and aged account collection.
  • Reporting. Use a single reporting system to drill down and analyze key performance indicators and deficient trends within the revenue cycle.

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