The process involved in Claims Denial Management - Identification.
Claims submitted to insurance companies oftentimes get rejected due to errors. Therefore, a denial management team analyzes these rejected claims and makes necessary rectifications, and resubmit them for successful claims. 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.
Identifying the root cause for the claims getting denied is the primary step toward good denial management. The claim adjustment reason codes (CARC) provided by the insurance company are analyzed and the reason behind the denial is established. A well-trained, highly-skilled team is required to do this since the codes tend to be quite complicated and confusing. Hence establishing a good denial management team is vital for maintaining a successful rate of low denials from the insurers which in turn ensures a healthy workflow for the healthcare providers, with uninterrupted revenue inflow for the services provided by them.