Denial management is a critical component of healthcare revenue cycle management, focusing on identifying, analyzing, and resolving denied claims to ensure that healthcare providers receive the revenue they are owed. A denied claim occurs when an insurance company refuses to pay for a service provided, typically due to issues such as incorrect coding, missing information, or non-compliance with payer policies. At Thrive Technologies, our comprehensive denial management services are designed to reduce the frequency of denials, address the underlying causes, and efficiently recover revenue by resolving denials. This helps healthcare providers maintain a steady cash flow and improve overall financial performance.
We receive denial notifications from payers through EOBs, ERAs, or payer portals. Our team immediately identifies the reason for the denial and categorizes it for further action.
We submit an appeal or corrected claim to the payer, ensuring that all necessary documentation is included. Our team monitors the status of the appeal and follows up regularly with the payer to ensure timely resolution.
After reviewing the denial, we conduct a root cause analysis to determine the reason for the denial. We then create an action plan that includes preparing documentation for an appeal, making corrections to the claim, and resubmitting it to the payer.
After resolving the denial, we work with healthcare providers to implement preventive measures that reduce the likelihood of future denials. This includes staff training, process improvements, and the use of claim scrubbing technology.
