Denial management
Today’s medical practices face more healthcare claim denials than ever before. A recent analysis of ACA exchange plans found that on average, HealthCare.gov issuers denied 18% of in-network claims (i.e., 36.3 million claims) in 2020. Why? Payer requirements are highly nuanced and dynamic. Just when you master one type of denial, you’re suddenly faced with several new ones. Working denials in healthcare has also become harder because of healthcare staffing shortages. There simply aren’t enough staff to review and address every healthcare claim denial. In addition, some revenue cycle staff don’t have the right experience to support appeals or manage clinical denials. Finally, many medical practices may not have the right tools to take a truly proactive approach to revenue cycle management and denial avoidance.
While medical billing is challenging, you can leverage edgeMED’s expertise. We use our proven strategies to raise reimbursement rates and diminish claim denials.
Our process
Effective healthcare denial management is about identifying the root causes of healthcare claim denials so you can prevent and manage them in a more strategic way.
Identify and analyze
Each medical claim is analyzed by edgeMED’s experts team to determine the best course of action.Strategy
We prioritize claims based on insurance payer, amount, age of bill, or other business rules to ensure maximum benefits.Prevention
Leverage best practices and cloud technology to prevent claim denials and identify areas for improvement.
We’re the experts you can count on
In the realm of healthcare denial management, clear and effective strategies are essential for preventing claim denials. Monitoring claim denials is a fundamental part of this process, as it allows us to proactively address and rectify issues as they arise. Our comprehensive denial management policies and procedures are designed to create a unified and consistent approach to addressing denials. We believe that you can't fix something if you don't know it's broken, and our commitment to proactive monitoring and strategic denial management ensures that potential issues are swiftly identified and resolved, contributing to a smoother revenue cycle.
At edgeMED, our team of specialists goes above and beyond standard payment processing. We don't just review and post payments, but we also automatically cross-reference them with fee schedules and reconcile payments. Furthermore, we proactively scrutinize claims to identify any errors or discrepancies and take immediate action to rectify or appeal denials during the payment posting process.
Our advanced automated tools play a pivotal role in preventing denials even before claims are submitted, thereby increasing the rate of clean claim submissions. By identifying and addressing potential issues before claims are dispatched, we enhance the efficiency and effectiveness of the revenue cycle.
Analyzing past denied claims is another crucial aspect of our approach. This analysis helps us detect patterns and workflow issues that might be contributing to denials. We compile these insights to help make informed decisions and improvements in your billing and claims processing procedures.
As your trusted revenue cycle management partner, we are dedicated to helping you achieve success in a cost-effective and efficient manner. Our comprehensive approach to claims denial management, along with our commitment to analyzing, preventing, and resolving denials, ensures that you can focus on delivering quality patient care while we take care of the intricate financial aspects of your medical practice.
Supercharge your practice!
Create efficiencies, streamline your medical organization and get paid more.
U.S. government entities
edgeMED is a U.S. Government Services Administration (GSA) contract holder (contract #47QRAA22D00E8) that provides federal and state governments with revenue cycle management services. Access to edgeMED ordering information, terms and conditions, pricing, and the option to create an electronic delivery order, are available to government entities through GSA Advantage!® at GSAAdvantage.gov.