denial management

de·ni·al man·age·ment

(dĕ-nī'ăl man'ăj-mĕnt)
A possibly criminal procedure in the U.S. whereby insurers employ subsidiary firms to find reasons to deny payment on legitimate claims.
References in periodicals archive ?
It turns out that most denial management programs have several flaws that, if corrected, can close the gap on those 90% of preventable denials.
Services within the revenue cycle continuum include denial management and appeals, aged insurance accounts receivable management, out-of-state Medicaid credentialing, and system conversion claim inventory recovery.
In addition to customer billing support, McKesson will provide coding and regulatory compliance, claims management, denial management and provider credentialing services.
She provides a data and information strategy assessment tool and discusses gap analysis management, denial management analysis, revenue integrity management, the integration of information roles, redefining workflows, competencies for transforming into a data-driven organization, and defining the role of the chief data officer.
This is achieved by reducing the number of denied insurance claims, speeding explanation of benefits (EOB) reconciliation, improving the quality of information, streamlining denial management, and automating processes.
Net presentation, and includes functionality for Enterprise Scheduling & Registration, Insurance Eligibility Checking (ANSI 270/271), Order Management, Patient Accounting, Billing, Collections, Contract & Denial Management, Document Imaging, Electronic Remittance Advice processing (ANSI 835), Claims Processing (ANSI 837), Medical Necessity Checking with ABN generation, Workflow Process, Dynamic Worklists and Business Intelligence (Data warehousing including KPI's, Business Analytics and Data Cubes).
Net presentation, InsightCS(R) includes Enterprise Scheduling & Registration, Insurance Eligibility Checking (ANSI 270/271), Order Management, Patient Accounting, Billing, Collections, Contract & Denial Management, Document Imaging, Electronic Remittance Advice processing (ANSI 835), Claims Processing (ANSI 837), Medical Necessity Checking with ABN generation, Workflow Process, Dynamic Work lists and Business Intelligence (Data warehousing including KPI's, Business Analytics and Data Cubes).
Charge and order matching 68% Charge capture reconciliation 63% Contract management 55% Denial management 50% Most Wired (Aggregate data for the 100 highest scoring respondents.
CSI) began to undertake the process in 2003 with the introduction of a denial management application to help hospitals track the denial rates in remittances received from insurance companies.
The system outlined below is divided into three parts: case management, denial management, and outcomes management.
HTSG's integrated, cloud-based offerings include myCLAIMIQ AlphaCollector[TM], a cloud-based collections management and A/R reporting platform; myCLAIMIQ Genie[R], a claims analysis software; and myCLAIMIQ AutoStatus[TM], automated claims statusing and denial management tool.
This agreement allows Conifer Health to deliver a suite of solutions, including coding and clinical documentation improvement, accounts receivable (A/R) follow-up, contract management, underpayment identification and resolution, denial management, self-pay collections and customer service.