Denial Management Software
Avisena's denial management software processes all responses from third-party payers. At present, each payer has a different set of reasons for which it denies. Under the HIPAA guidelines, there is a standardized set of denial reasons. Avisena has adopted these reasons as the standard and works to translate any denials that occur into this code set. Each denial and associated remark is posted against individual open receivables within a claim. In fact, if individual items on a claim are denied for different reasons, each reason is captured. One can imagine how this can make for effective denial management as hospital billing software or for private doctors and their practices.
Once a denial is posted, Avisena's Denial Management Software automatically pushes the denial to the Reimbursement Management System for immediate processing by an Avisena collector. In the Reimbursement Management System, Avisena's collectors can seamlessly check electronic claim status, document all interactions with the insurance company and the patient/responsible party, send a letter to the insurance company and/or patient, edit the claim and resubmit it, bill the patient, and send the item to appeal. Avisena performs this process seamlessly with complete visibility.
- Third-party payer reimbursement and adjudication practices can be tracked and reacted to.
- Receivable history is tracked and communicated to all parties involved.
- Reimbursement amounts can be compared against pre-assessed value to detect underpayments.
- Enables the ability to learn from real responses. For instance, each denial that occurs is an opportunity to create a new rule in the Rules Engine to prevent the denial from happening again. This makes for excellent physician or hospital billing software.
Posting of the full remittance with Denial Management Software provides the following benefits:
