The proper and timely working of denials can generate additional revenue for any medical practice. At Medigistics denials from carriers are immediately pursued because with denials the clock is ticking and if action is not taken quickly our rights to appeal and your revenue could be lost. As mentioned earlier our goal is to submit a clean and payable claim the first time. We do this by reviewing claims and comparing them to known edits before submission.

The system has a denial report that is run and the data is organized to track and trend types and frequency of denials. We have also developed our own custom report that is generated each month that reports on all charges where the adjustment amount equals the original charge amount. This identifies claims that we were unsuccessful in getting paid after an initial denial.

Other actions :

If a particular payer is identified as having a pattern of denials we contact the provider relations department and request that they follow the claims through their system to determine why.

Many requests for reviews of denials can be submitted online. We take full advantage of these capabilities if the payer can accommodate these types of requests.