Denial Management

Denial Management

Denial management is a subsection to Accounts Receivables of any medical facility, we religiously follow the below methodology of managing denials from payers. Our solution is focused around these three key fundamentals:

  • Prevention
  • Analysis
  • Tracking and Trend Management


Prevention focuses on actions that can be taken upstream in the patient encounter to prevent denials from occurring in the first place. Prevention can be introduced anywhere in the patient encounter such as: Pre-admit/Pre-registration, Scheduling, Admit/Registration and Billing. Our experts ensure that we track such trends and keep the Client informed periodically about improvements/process changes that can be made across functions.


The process of analyzing and aggregating similar denials is strategic in denial management. At Opus, we understand that analysis and segregation is a forerunner to follow-up process and hence for us it is a fundamental step in denial management.


Besides keeping a track of the denial trend from payers our experts also actively monitor the payment patterns from various payers and set-up a mechanism to alert when a deviation from the normal trend is seen. This is important in understanding the causes of claim denials and enhancing long-term efficiency and drastically reducing lost revenue.

Denial Follow up:

  1. Identify the root cause of denials - Collecting and interpreting patterns to quantify denial causes and their financial impact.
  2. Prepare accurate workflow priorities and scheduling for follow up - Collecting information on denial appeals, including status, escalation, correspondence with payers, and the disposition of the appeals to increase recovery amounts.
  3. Track, prioritize & appeal denials - Generating appeal letters based on federal and state guidelines favoring the medical provider.
  4. Analyze the effectiveness of the resolutions.
  5. Identify business process improvements to avoid future denials.

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