The Best Denials Are No Denials
What if you could completely avoid denied claims? Well, we know that insurance companies are not in the business of paying claims. They’re in the business of collecting premiums. So there will always be denials. However, using “delicious data,” Advicare helps providers better understand the cause of denials and avoid them going forward.
Prevention Programs That Work
Our prevention programs cover a lot of ground, including creating a strategy, staying on top of denials, and developing clear reporting guidelines.
By having Advicare collaborate with your organization, you’re allowing our experts to take a “bird’s eye view” of your business, including the root cause for your denial prevention, the percentage of avoidable clinical denials, and how you address accountability in your organization.
We will help you build a Denial Avoidance Team to leverage your skills – along with ours – to drill down the root cause of denials and prevent them in the future.
Denial Prevention & Workflow Management
Sometimes, it’s not what you do, but how you do it. We can help you put systems in place for denial prevention. We will work with your team to augment your understanding of all payer requirements, from documentation and preauthorization to allowable claims and proper formatting. In addition, we will help you optimize your revenue cycle and determine all forms of avoidable clinical denials, including:
Lack of medical necessity | No authorization | Delayed discharge
Investigational procedure | Level of care
A Closer Look At Your Data
At Advicare, we help your team track and measure all data, as well as sharing relevant data with other departments within your organization. We identify trends – with your help – to find areas where you can avoid denials, and where you can collect money faster.
As your healthcare organization’s partner in overturning denied claims, Advicare will review thousands of claims submitted to payers on your behalf. During that process, we accrue data and use advanced analytics to identify commonalities among your denied claims.
In addition to examining your processes, we look for problems – as well as opportunities – presented by payers. From clinicians on the front line, to payers, to schedulers responsible for prior authorizations, we will uncover the root causes of claims denials and report them on a quarterly basis.