AR & Denial Management

AR & Denial Management

According to the American Medical Association (AMA) reports, between 1.38 percent and 5.07 percent of claims are denied by insurers on the first submission. It is a very pivotal part of any medical & non-medical providers to maintain account receivable management in smooth and timely manner. Account Receivable Management is the process of collection of work including identification of denied/unpaid claims, re-filing of the corrected claims from aging slots.

Do you want to increase reimbursement rate and save your business financially?

 CareClaimz is here to assist you with your AR Management through our well- organized process where our AR department reviews and categorize the denial reports, rejection Code, Reason Code, containing information on denials and write-offs Trends. The audit team investigate and analyzes previous denials trends and pass the correct instructions to the billing department in order to reduce the error rate in future billing. Then analyze the denial issues log and review the trends in insurance denials that had been identified in order to determine whether the actions taken were effective enough to reduce similar denial in future.

Our Audit department investigates and prepares AR trends reports and their top priority to resolve your account receivable issues such as demographic and claim entry errors, inconsistency in Billing, Coding and modifiers errors, Claim Adjustment Group Code, Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), provider credentialing and enrollment contract negotiation matters, Investigate claim on file submission status through Electronic Data Interchange (EDI) 837 professional and institutional or EDI file. They also get the confirmation of receiving data in the HIPAA compliant Accredited Standards Committee (ASC) X12N 835 file format knows as Electronic Remittance Advice (ERA) and also reconcile the Insurance/payer payment into Bank deposited through Electronic Fund Transferred (EFT). The Claim Department also get in touch with Centers for Medicare & Medicaid Services (CMS), MACs like Noridian Healthcare Solutions, LLC, CGS Administrators, National Government Services, Inc. Novitas Solutions, Inc. Palmetto GBA, LLC. Wisconsin Physicians Service Government Health Administrators and Clearinghouses.

We are among fastest growing Revenue Cycle Management Companies and we tailor our services according to your practice and business needs. We drive your business in new directions of financial growth.

  • Investigate, Classify, Organize, Monitor, Prevent Account Receivable financials
  • A/R categorized by financial payer’s and Patient Financial Services
  • In-depth knowledge on insurance rejections & denials management
  • Identify Health plan products, Administrative policies, and Network adequacy
  • Identification and diagnoses of the issues in order to fix them to get faster reimbursements
  • Regular and consistent follow up of practice aging reports