Learn how automated resolution is only part of successfully managing denials.
How would you describe your current approach to denials management?
Gladys Quince: “We've developed a system where we are ‘walking backward through our denials.’ And what that means is we look at our denials, identify what the trends are, and then we're trying to figure out what is the related root cause, how did that happen? So we may be 'botting' or automating the function to take care of it, but then we're also going upstream to say, ‘Was that caused by eligibility,’ ‘Was it caused by a medical necessity issue,” etc. And where was the first point we could see that going off track? And then we’re trying to put some proactive measures in place so that we don't have the problem repeating. So if the payer is expecting it (the needed information), we're not overlooking it again, and then having to waste our time at that point trying to figure out how to send an appeal or process an appeal or get rid of the balance because (the information) has already been provided up-front.”
