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How To Manage Denied Claim Appeals to Maximize Your Revenue?

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23 Mar

How To Manage Denied Claim Appeals to Maximize Your Revenue?

How To Manage Denied Claim Appeals to Maximize Your Revenue?

Denied claim appeals refer to the process of challenging a payer’s decision to deny reimbursement for a healthcare service or treatment.

When the insurance company denies a claim, you can file an appeal to challenge and potentially overturn the decision. The appeal process involves submitting additional information, documentation, or evidence to support the claim and requesting a reconsideration of the original decision. Different levels of appeals are available to each payer, all with specific requirements and deadlines.

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Want a faster denial and appeals management process? Read below for more tips and details about how the TriumpHealth medical billing services team tackles how to manage denied claim appeals.

Firstly, TriumpHealth assigns a medical billing specialist to your practice to work on any claim denials from a payer. The assigned specialist follows through with the steps below.

Understand the Reasons for Denial

When initiating an appeal to an insurance company, the initial step is to comprehend the rationale or reason behind their denial, e.g., medical necessity, coding, LCD guidelines, etc. After receiving the EOB (Explanation of Benefits) with specific denial codes, document the claim decision fully. If unclear, contact the payer directly. It is the medical providers’ right to acquire claim denial information, and payers must explain it in an easily understood language.

Eliminating The Easy Issues

Claim denials can stem from numerous factors, with data entry errors being among the most frequent. These can manifest as patient demographic errors, including misspelled names, erroneous insurance policy numbers, mismatched dates of services, etc. It is crucial to thoroughly examine the documentation furnished by the insurance company and scrutinize it for any errors. If discrepancies arise, the TriumpHealth medical billing specialist alerts the insurance company representative to rectify them. Then, the specialist corrects and resubmits the claim for payer adjudication.

Collecting The Evidence

Unnecessary denials of claims can also arise due to the provision of services that are not deemed medically necessary. To avoid this, it is imperative to have sufficient proof and documentation supporting the treatment or services offered, obviating the need to demonstrate their medical necessity later. Referrals and other pertinent information regarding the patient’s medical history can aid in approving the claim. It may be advisable to refer to the health plan’s policy or guidelines for the services being billed, which can be accessed online through the payer portals.

Organization is Key

TriumpHealth medical billing services store all paperwork in a secure, HIPAA-compliant portal to ensure organization and transparency. They organize billing paperwork into clearly labeled folders for easy access by payer, patient name, and service date.

Submitting The Essential Documents

The necessary appeal letter is based on a template for particular CPT codes and payers. The appeal letter is faxed or uploaded, containing the claim number and relevant patient details. Typically, payers handle claims submitted via their standard appeals form or portal more expeditiously. The EOB from the insurance company may also provide information about the appeal process.

Are you seeking one of the best medical billing companies in Texas? If yes, contact TriumpHealth at 888-747-3836 x0 today and speak with a medical billing expert. Our trustworthy solutions make you manage denied claim appeals process easier and more efficient!