Prior Authorization Services
Administrative coordination of authorization requests: documentation, submission tracking and follow-up.
Service
Denial Management Services
Review of denied claims, correction and resubmission, and appeal-support workflows with clear records.
Overview
About Denial Management Services
A denial is a payer decision not to pay some or all of a processed claim. The reason may be a data error, a missing document, a coverage issue or a disagreement about the service. Each reason needs a different response, and each has a deadline.
We help your practice work through denials in an orderly way: identify them, understand the stated reason, correct what can be corrected, and prepare the documentation that supports a resubmission or appeal. Decisions on whether to appeal rest with your practice.
What the work can include
- Identifying denied claims from payer remittance information
- Reading the denial reason and sorting items by what they need
- Correcting data errors and resubmitting within payer deadlines
- Preparing appeal documentation for your review and signature
- Recording recurring denial reasons so that causes can be fixed upstream
How it fits with your team
Denials often point to a problem earlier in the cycle, such as registration data or missing authorization. We summarise patterns so your team can address the cause as well as the individual claim.
Common challenges
Where administrative work tends to get stuck
Practices come to us when routine business tasks start taking more time and attention than they should.
-
Work without a clear owner
Tasks are shared between people who are also busy with patients, so follow-up is easy to miss.
-
Inconsistent processes
Each person does the same task a little differently, which makes errors harder to spot.
-
Scattered documentation
Information sits in email, paper files and separate systems, and is slow to find when it is needed.
-
Limited visibility
It is hard to see what is in progress, what is waiting and what needs a decision.
What the support covers
How we support your team with Denial Management Services
The exact scope is agreed with you, and it depends on your practice and your systems. In general, our support covers these areas.
-
Workflow review
We look at how the work is handled today and agree how it should be handled from here.
-
Day-to-day handling
We carry out the agreed tasks on a regular routine, following your instructions and preferences.
-
Follow-up on open items
We keep track of work that is waiting on someone, and raise it with you when it needs attention.
-
Documentation
We keep notes and records of the work in a consistent format that your team can review.
-
Regular updates
We keep you informed about progress and anything that needs your decision.
-
Ongoing adjustment
As your needs change, we review the arrangement with you and adjust it.
How it works
How Denial Management Services support is set up
A simple, four-step approach that keeps you informed at each stage.
-
01
Review
We learn how your practice handles Denial Management Services today: your people, systems, payers and priorities.
-
02
Configure
We agree what we will take on, how we will work with your systems, and how we will communicate.
-
03
Manage
Our team carries out the agreed work on a regular routine and keeps records of what was done.
-
04
Monitor
We review progress with you, share what we see and adjust the approach when something changes.
Benefits
What working with us is designed to give you
-
Workflow clarity
Everyone knows what is being done, by whom and what comes next.
-
Administrative consistency
Work follows defined steps, so it looks the same from one week to the next.
-
Better documentation
Records are kept in an organised way that is easy to check and hand over.
-
Visibility
Regular updates show you where things stand without you having to ask.
-
Operational support
A dedicated team shares the routine workload with your own staff.
-
Flexibility
The arrangement can be reviewed and changed as your practice changes.
Who it supports
Support for healthcare businesses
Our Denial Management Services support is designed for the people who run healthcare organizations: physicians, medical practices, clinics and healthcare groups.
Specialties we support
Explore the medical specialties this service applies to.
Related services
Other ways we can help
-
-
Accounts Receivable Management Services
Follow-up on aging accounts and outstanding balances, with reconciliation and reporting support.
-
Eligibility Verification Services
Administrative checks of coverage and benefits information before appointments, so billing starts from accurate details.
FAQ
Questions about Denial Management Services
Answers to questions we are often asked about this service.
-
No. Payers make the decision. We make sure each denial is reviewed, corrected where possible and followed up within the deadlines that apply.
-
Your practice does. We prepare the supporting documentation and tell you what the deadline is.
Talk to us about Denial Management Services
Tell us what your practice needs and we will explain how our support could work.
Please do not include patient information.