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Proactive Denial Management Procedures to Lower your Claim Rejection Rate

Take a look at these denial management tips that can help you lower your rejection rate.

Hearing the word “denial” is rarely ever going to something you want, especially when you’re the one receiving the denial. Medical claims are sensitive documents. They require careful scrutiny before they get submitted, and they will get denied if they don’t abide by particular criteria. The requirements for medical claims vary by insurance company, meaning that while all claims are similar, they aren’t all the same. If medical claims aren’t handled properly, it can be a serious problem. Take a look at these denial management tips that can help you lower your rejection rate.


While speed is valued in any workplace, it can be a risk factor for accuracy. A majority of typographic errors stick around because there isn’t a fresh set of eyes around to review everything. Having someone else review the work makes it more likely to detect errors you may not have seen. That’s what makes proofreading an effective denial management practice. Even if it takes a little extra time, it’s well worth it to make sure there aren’t any errors in your work.

Demographic Data from Front Desk

This is a job that relies greatly on the front desk. It’s essential to capture and gather the right demographics and then send the data to the billing department. Failure to complete this task will mean that all other parts of the process will be done for nothing. For this reason, billing departments should work closely with the front desk, and they should check as well as cross-check details for every patient visit.

Verification of Eligibility

This is another crucial step for dealing with denial management. You need to assess the eligibility of the patient. This is something that the billing software would normally verify in the midst of a patient’s visit.

Insurance Company Validation

This is a step in the denial management process that can go wrong in many ways. A patient could have multiple insurances, so if you send a claim to the wrong insurance, your claim will get rejected. Each insurance company could have a different template, so you all of the fine details have to get validated before you can submit your claim.

Insurance Requirements

You have to be up to date with the industry. Every little change can disrupt your process and impact the system. Sometimes, it’s not even industry change that occurs. It could be a carrier that makes changes. That’s why you need to keep on your toes and stay current on all of the news that pertains to the industry or your insurance carriers.

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This entry was posted on Thursday, November 14th, 2019 at 8:09 am. Both comments and pings are currently closed.