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Claims Denial Management

Analyze, Diagnose and Take Action

Developing customized solutions to your specific denials trends is the key to being successful. Every organization has it's own unique challenges. Identifying denial trends early and implementing the fix will contribute to the success or your organization. Insurance policies often, and your organization must be capable of pivoting to meet the expectations in this industry.

How we providing support to our Physician Practices

Denial management is about identifying the root causes of healthcare claim denials so you can prevent and manage them in a more strategic way.

  • Identify and analyze
    Each medical claim is analyzed by edgeMED’s experts team to determine the best course of action.

  • Strategy
    We prioritize claims based on insurance payer, amount, age of bill, or other business rules to ensure maximum benefits.

  • Prevention
    Leverage best practices and cloud technology to prevent claim denials and identify areas for improvement.

 

Claims often get denied due to incorrect insurance information, provider detail errors, or errors in patient demographic entry.

  • Our follow up team not only review, post, automatically compare against fee schedules and balance payments, we also analyze, correct, reprocess or appeal any denials at the time of payment posting.

  • Our automated tools identify errors prior to submission in order to increase the clean claim submission rate.

  • We analyze past denied claims to identify patterns of workflow issues and report back results.

 

Medical practices can avoid many of these types of healthcare claim denials using clear healthcare denial management strategies. One of the most important ones? Monitor claim denials. You can’t fix something if you don’t know it’s broken. With edgeMED, our denial management policy and procedures promote a unified and consistent approach. We are a revenue cycle management partner that can help you achieve success in a cost-effective and efficient way.

Knowledge + Teamwork =Success

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