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Plot No. 27 Scheme No. 54, Vijay Nagar Indore - 452010
Mon - Fri: 09:00 - 05:00
Denial Management is a critical component of Revenue Cycle Management (RCM) in healthcare, focusing on preventing, identifying, analyzing, and resolving claims that have been denied by insurance payers. Effective denial management ensures that healthcare providers maximize reimbursements and reduce the number of claims that are denied or delayed.
A denied claim is a claim that an insurance company refuses to pay, typically because of errors or discrepancies. This differs from a rejected claim, which may not have even been processed due to basic errors, and can be resubmitted after corrections. A denied claim, on the other hand, has been processed by the payer but payment was denied.
Denial management involves understanding the reasons for denials, preventing future denials, appealing incorrect denials, and resubmitting claims where appropriate.
The patient may not be covered by the insurance on the date of service, or the services provided might not be covered under the patient's plan.
Claims may be denied due to incorrect or missing patient information, coding errors, or incorrect provider information.
Common issues include
Most insurance companies have strict deadlines for claim submission. A claim submitted after the deadline can be denied due to untimely filing.