Healthcare Claim Management: Claim Denial Automation Tips

Health & Medical Blog

Although most people don't like to think about them, healthcare claim denials are a part of the industry. Unfortunately, they are also the most time-intensive in many cases because much of the validation that happens is done manually. This can be time-consuming and it leaves a lot of room for human error. That's why you should look for some automated denial features in your healthcare claim management solution. Here's a look at some of the features that you should look for to simplify claim denial.

Duplicate Claim Comparison

One of the very first things that should be done every time a claim is entered into your management platform is a check for duplication. Sometimes, claims are submitted more than once due to human error or assumptions that they weren't received. These duplications can be costly if they're overlooked, and the time it takes to verify them manually can be prohibitive. That's why you should look for a claim management solution that checks all newly entered claims against those already in the system to identify duplicates automatically.

Timely Submission Verification

For every claim submitted, there's a timeline for when it must be submitted in order for it to be considered valid. If the claim is submitted after that time has passed, it may be denied. You can look for a claim management platform that verifies the date of the claim against the date of service to ensure that it is still a timely submission before proceeding with the rest of the process.

Coverage Validity Confirmation

With the right claim management solution, you can also have your software verify that the patient listed on each claim had valid coverage at the time of the procedure, saving you from having to verify coverage on every single claim. This confirmation process also reduces the risk of a claim being paid despite a lapse in coverage.

Prior Authorization Validation

For many health coverage plans, prior authorization is required for certain types of care and specific procedures. If a patient fails to obtain that authorization from the insurance provider or referral from their primary care doctor, the procedure is not covered under their policy. You should have a claim management solution that includes input fields for prior authorizations so that the system can automatically validate those authorizations before verifying the claim.

These are some of the most common reasons why healthcare claims are denied, and they can easily be automated by your claim management platform if you choose one that includes the capacity. Save your claim management staff hours of manual labor by automating some of your claim denial process. A company like Bill Accurate Inc has more information on this topic.


21 March 2022

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