Claims Denial Management

Claims Denial Management - Monitor

Insurance companies oftentimes reject the claims submitted to them due to errors present in them and these errors are given specific codes to denote the reason for the denial. A denial management team analyzes these rejected claims and makes necessary rectifications and resubmits 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.


The denial management team, to ensure a successful claim, rectifies the errors in the claims and after resubmission, keeps a close monitor, to keep everything on track. It is important to keep a close monitor in order to ensure a successful claim.

Firstly, the denials are categorized based on the type, date received and appealed, and disposition. Next, the team's work is audited by sampling and evaluating. Then it is ensured that sufficient resources are provided to them so that their job is done smoothly and efficiently. By having a good understanding of the time, source, numbers, and type of denial, a good channel of communication can be established with the insurers to avoid future claim denials.

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