Healthcare Denial Recovery with ClearContracts
Features
ClearContracts™ for Denials enables providers to track and resolve denied claims as well as identify the root cause of the denials to prevent them from occurring in the future. Denied claims can amount to as much as 25-30% of all health care claims, translating to millions of dollars of avoidable write-offs.
Denial Identification
- Track denial reason code; map to standard list
- Physician Advisory services
- Monitor hospital activities and initiate action-oriented workflows when problems are identified, before they result in denials.
- 835 and Paper EOB (EOB Pro) reason code capture
Denial Recovery
- Auto-track process of denial recovery
- Standardized workflow for easy follow-up
- Make informed appeal / no appeal decisions utilizing appeal history
- Assign appeal tasks based on user-defined rules
- Appeal and litigation support.
- Cross-departmental workflow management organizes, prioritizes, and monitors denial-related tasks to maximize revenue recovery.
- Assign and monitor appeal tasks to ensure that appeal efforts are focused where they will have the largest financial impact.
Denial Concurrent Overturn
- Log to trigger immediate denial
- Automatically generate reminders and alerts that ensure timeliness requirements are met
Executive Performance Reporting
- Track key performance indicators such as Denial Rate, Overturn Rate, and Time-To-Collect.
- Analytics and detailed management reporting identifies root causes, patterns and financial impact of denials - enabling correction of process break-downs.
- Prepare for data-driven contract negotiations by tracking individual claims and identifying problematic contract terms.
