A Process in Claims Denial Management - Prevent

A Process in Claims Denial Management - Prevent.

Claims submitted to insurance companies oftentimes get rejected due to errors. Therefore, a denial management team analyses these rejected claims, makes necessary rectifications, and resubmit them so that healthcare organizations have a healthy revenue inflow. This process of analysis, submission, and successfully claiming the payment is denial management.

A good denial management team adheres to the IMMP process, a technique, i.e., Identify, Manage, Monitor, and Prevent which is essential to reduce/prevent denials.


After collecting the information regarding claims denial, the foremost step to be taken is to devise methods to prevent similar denials from occurring in the future. Hence, the denials must be carefully examined and categorized according to the team that contributed to the denial, retrain them, and walk them through the whole process again. Any adjustments necessary to the workflows must be made and the processes as a whole should be revisited and changes made to it if needed. A viable program must be formulated to prevent claim denials and the departments that had contributed to denials must be made to undertake training under this program.

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