Denial & Appeal Management
Acting on a provider’s behalf to achieve a good resolution to claims denial
We’re on your side when a claim is denied
When a claim is denied both the patient and DocFinancial receive a denial. We contact the patient, introducing ourselves as part of our client’s office. These are frequently complex situations but our staff have years of experience untangling the forces at work in a denial.
Our first step is to establish which insurance company is the primary and which is secondary. The patients very likely don’t know but we can readily sort this out. Then the real complexity begins.
Clarifying Coding Errors
When various interested parties are putting in coding, the wrong diagnosis code may be used. For example, if someone sees that the diagnosis code is “Cataract for juvenile,” that raises a flag. We delve deeply to make sure the code is correct, that the insurance matches, that authorization issues have been addressed. When dealing with overseas outsourced services, we aim to get it transferred onshore. Getting all parties involved to compare their documents, tell their story and work to break logjams.
Traveling through multiple appeal levels, until all issues are resolved
Another wrinkle in the appeals process is that every insurance company has different rules. This does not deter the professionals at DocFinancial. We take our clients’ case through first and, if necessary, through secondary levels of appeal. Ultimately, the insurance companies bear in mind that they want a happy client and so settlement will eventually take place. DocFinancial does everything possible to avoid denials, but when they occur, we resolve them with minimal disturbance to the provider practice.
