Our solution is based on following steps:
1 . Follow-ups
ACS, Inc. tracks denials, logs what has been denied, why, how, and when the claim was filed to greater levels of detail than any of our competitors.
Possible reasons for denial include:
- Coding: Denials caused by coding issues can include bundled codes, a diagnosis that is inconsistent with the procedure and invalid codes, missing modifiers, undocumented proof of medical necessity, etc
- Front Desk Issues: Registration, referral and authorization errors can contribute to denials. These errors can include a subscriber who is not enrolled, an incorrect claims address and lack of referral or authorization, etc.
- Billing: Denials caused while billing claims can include errors in keyed data, credentialing (a provider is not enrolled), duplicate claims, untimely filing, problems while filing claims, etc.
- Insurance Company: Denials caused by an insurance company can include lost claims, requests for additional information from the patient or provider, computer system problems, etc.
- Pre-adjudication (accepted/rejected claim status)
- Claim pending for development (incorrect/incomplete claim(s) within adjudication process) or suspended claim(s) requesting additional information
- Finalized claims. Further defined, finalized claims may have outcomes that include finalized rejected claim(s), finalized denied claim(s), etc.
2 . Denial Management
Denial Management involves:
- Analysis of reason codes
- Action taking-corrections of claims
- Re-filing of claims