Claim Denials

Isolating Claim Defects and Denials

Isolating Claim Defects and Preventing Denials with Automated Process Improvements 

Errors and defects in medical claims are inevitable. A small percentage of them will eventually turn into a denial. How you handle defects and exceptions, however, can lead to significant dollars being delayed, or lost entirely, due to the additional work being required to collect on denied claims.

ReMedics utilizes Business Process Automation (BPA) to quickly isolate claim defects – providing for efficient corrections to quickly be made by our remittance processing staff. Our internal platform automatically identifies and flags defective claims that need to be adjusted, or have specific missing information, along with access to EOBs and Correspondence document images for accurate, efficient correction. By processing more ‘clean claims’ with automated data validation rules, cash flow is improved and less work is required downstream by A/R staff to collect payments. 

If exceptions and denials do occur, they are automatically routed to a client-defined work queue, facilitating timely and effective resolution. Image-enabled worklists allow users to simultaneously view an exception or denial, along with and historical patient billing information to efficiently update claims.

ReMedics also provides management with dynamic drill-down reporting to resolve the root cause of higher-volume claim defects or reduced payments by insurance payors, preventing future occurrences and profit losses. Our clients can also analyze the effectiveness of their follow-up procedures and uncover hidden trends that can lead to permanent revenue cycle improvements.

Talk to ReMedics about how we can can help to manage and reduce your claim defects and denials with automated processes. Contact us online — or call 440-671-7700.