Manage - A process in Claims Denial Management
Claims denial management attempts to eliminate the reasons leading to denials in medical claims. Further, the denial management team analyzes and tries to ensure that the same doesn't occur in the future and helps organizations achieve a healthy financial operating condition.
Insurers deny claims that have errors and assign codes to them. A denial management team analyzes the trends in the claim denials and rectifies them to avoid future denials.
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 the process of identification of the reason for the denials, the team then resolves the errors by
- Routing denials to coders - With the help of automated tools, denials are organized and sent to coders so that they can quickly rectify them.
- Use of software for Sorting - With the help of various software, the denials are sorted based on time, amount, reason, etc., and are distributed accordingly for rectification.
- Use of default methods - After sorting, immediate action is taken according to the methods prescribed. Noting the most common reason and code and then devising a plan of action for future denials.
- Device a plan - To prevent future denials, the team creates do's and don'ts and checklists depending on the codes for denials.