What Makes Healthcare Denial Management Services Excel?

Posted by Advent Health Partners on Apr 13, 2017 10:42:25 AM

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Denial has such a negative connotation. However, with an effective technique, it's possible to turn a denied claim into a paid claim. It just sometimes requires effort and a change of approach. Here are five strategies to improve your healthcare denial management.

1. Get Organized

If you're not already organized, you need a plan of attack to manage the claims in an organized fashion. You must keep all your claims together and have a system for them. Keep in mind, if you lose track of your denial claims, you've lost that money completely. There isn't a chance of you recovering if you don't know it's there. You might not notice if you lose one or two claims, but if it continues, your revenue will show it. And if you're not organized, you might not even notice when a claim goes missing.

See how the right denial management strategies can pay off - Read Case Study

2. Complete the Claim Denial Process Promptly

Time management is key in the denial management process. Time really is everything. You need to be able to keep up with the speed the rest of the world travels. Generally, you want to complete the claims denial process within a week. Once you receive the claim, give yourself no more than seven days to complete it. Use your organization technique to keep yourself on track. If you let that claim sit in claims' limbo for too long, you might forget about it. Not to mention, insurance companies usually have time limits established; it helps them to not have to pay for claims. However, if you're on top of it, you'll beat the deadlines and see the return from your efforts. Having a schedule for healthcare denial management claims also helps you establish a more effective and efficient system.

3. Monitor Your Progress

You should be monitoring your progress, so you can see how successful your process is. Regularly evaluating your progress aids in establishing where the weaknesses of your plan of attack are. Once you identify the areas that require additional support, you can alter your system accordingly. This can be a continual process, so you're always growing and adapting your process to the actual needs of your establishment. Remember, there's not a one-size-fits-all strategy to denial claims management. You need to create what works for you, and sometimes, what works for your facility is going to change over time.

IBM was able to take these strategies and see incredible results - Read Case Study

4. Take Notice of Denial Reasons

Although every claim is different, take notice of the reasons why claims are denied. They tend to vary from facility to facility, so you'll need to evaluate your specific denied claims. The most common reasons for denied claims may change over time. However, the most common reasons for a denial are due to a coordination of benefits, accident details, pre-existing conditions, errors in the spelling of a name and PIP application. Compare the denial reasons and note any trends involved with the denial claims. Although these seem like minute reasons, they're sometimes part of a larger picture. By careful analysis, you can identify issues that may be the fault of your facility. It can help you to craft a more effective system and strategy and determine if more patient involvement is necessary.

5. Plan for Tomorrow

You always need to be looking ahead. The healthcare denial management process isn't just about what's happening as of right now. You have to consider what's going to happen in the future. It helps to make a course of action based on your research of trending issues for denial management.


The “D” in denied doesn't have to stand for definitely. By evaluating your approach and customizing your process, you can convert those denied claims into paid claims. Ultimately, you'll increase the revenue you generate and reduce the stress your patients feel from a denied claim.

Read Case Study

Topics: Claim Denials, Claim Denial Management