Data Entry Errors
The majority of claims are denied because of simple typos. Misspelled names, transposed numbers and incorrect gender can cost healthcare organizations tens of thousands of dollars a year.
Coding errors are some of the most common reasons for denied claims. Errors can occur simply because software has not been updated to new coding rules. However, they often happen because of invalid code and modifier combinations, lack of specificity and procedures deemed not medically necessary because of diagnosis coding.
Insurance coverage changes. Eligibility checks and insurance verification are often not completed, and information is no longer accurate, leading to denied claims that may not recoverable.
Billing and Timely Filing Errors
Billing and timely filing errors account for another large portion of claim denials. These issues arise from missed deadlines, omitted information and duplicate claims.
Denials for authorization do not mean a provided service is not eligible for coverage. Usually, the authorization either was not obtained before the encounter or the proper documentation was not linked or attached to the claim.
Prior Authorization Required (Referrals)
Some payers require a physician authorization or referral in order to verify the medical necessity of a specialty visit. These denials are easily avoidable and can impact patient satisfaction when the encounter is not covered.
Each new denial represents a painful drain on labor and revenue. Despite advanced technology and analytics, stubborn denials persist and seemingly cannot be resolved.
Tell us your top denials to customize the tool your team needs to prevent them!
Our Solution Main Features
Flexible Rules Engine
Alarm all your top denials by setting relevant rules to monitor information, follow-up on exceptions and confirm problem resolution before claims submission.
Drill Down Analysis
Our drill down feature gets to the root causes of denials, so you can accurately identify when and where corrective actions need to be taken.
Actionable real-time analytic reporting allows you and your team to fully adapt the tool to your needs. As your requirements evolve, the tool can be modified to any new reporting configuration.
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Empower your denial management team and reduce your denial rate at least 50% with next generation claims efficiency powered by Effy Healthcare.
In addition to quickly boosting revenue and delivering a swift return on investment,
Effy Healthcare offers benefits such as:
Reduced and eliminated denials
Lower days in A/R
Higher payer and patient collections
Decreased manual workloads
Easy-to-use performance reporting and analytics
A sustainable program to continually improve efficiency