Denial Management

The typical U.S. hospital can easily experience initial denial rates of seven to ten percent of its claims. A common best-practice recommendation is to hold the initial denial rate to four percent or less. For many organizations, even that level of revenue exposure can mean the difference between operating at a loss and staying in the black.

InSight Denials is designed to drill into your 835 remittance data to uncover the root causes leading to denials. It analyzes, tracks, trends, and reports on denial data, identifying unpublished rules and recommending fixes for individual denied claims while helping you identify and implement process improvements to eliminate recurring denials and optimize revenue. Rely on InSight Denials to:

  • Provide all users with a single, on-demand view for managing all aspects of claims denials, from receipt to resubmission.
  • Manage claims denials from all payors.
  • Drive initial denial rates below the industry best practice 4%.
  • Produce custom reports with data beyond the standard 835 dataset.
  • Provide key trending reports to measure the impact of process improvements.
  • Deliver full compliance with HIPAA technical security and privacy provisions.

Denial Workflow Distribution

InSight Denials expedites the repair and resubmission of denied claims for cross-departmental teams. An intelligent workflow engine applies customer-specific logic to efficiently distribute denied claims requiring resubmission to the right departments and individual team members and maintains a detailed history of actions on all claims.

When claims involve multiple teams, the workflow engine also supports communication and corrections across them all, tracking denied claims until they are resubmitted to the payor.