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Home » Revenue Cycle Management » Denial Management

Denial Management


Denial Management

e-care India is dedicated to minimize lost reimbursements and denials with highly efficient systems and services designed to meet our clients’ needs. One of the major problems faced by healthcare providers and medical billing companies is that a large proportion of rejected claims goes unattended and is never resubmitted. e-care’s Denial Management process uncovers and resolves the problem leading to denials and shorten the accounts receivables cycle. The denial management team establishes a trend between individual payer codes and common denial reason codes. This trend tracking helps to reveal billing, registration and medical coding process weaknesses that are then corrected to reduce future denials, thus ensuring first submission acceptance of claims. Also, the payment patterns from various payers are analyzed for setting up a mechanism to alert when a deviation from the normal trend is seen.

Appeals for Denied Claims

For claims that are denied and need to be appealed, appeal letters are prepared and sent along with supporting documents including Medical Records for processing. If the insurance permits telephonic or fax appeals, the same is also handled through those channels

Patient Follow-Up

e-care has a separate team of executives dedicated to calling only patients. Calls are made to patients to obtain missing demographics, insurance information and also discuss outstanding patient dues. Each patient account is meticulously tracked and followed-up by our trained and experienced staff till the payment is received. Processes are clearly laid out involving sending letters, statements, notices, making phone calls, etc. to expedite collections.

Credit Balance Audits

During the process of collection retrieval, an audit of all the accounts is undertaken to reconcile unidentified and duplicate payments. Processes are set such that the payer and patient overpayments are refunded or adjusted as per the policies of each client. Refund requests are prepared and sent to the clients to handle necessary refunds, after thorough research of the patient account to establish overpayments.