HomeTown Health InformationPrevent and Work Denials with Technology!

Provided By:Kerry Elledge, Quadax

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Generic 835 Screenshot

ANSI 835:

Loops, Segments and Data…Oh My!

Convert to “Human

Readable” EOBs

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Without technology, data consolidation is difficult and

excessively manualTechnology allows for consistent reporting, data mining, data sharing and root cause analysis. There is too much data to handle manually and there are limited resources already at hospitals. Minimizing/preventing denials is one

of the greatest opportunities a hospital has to improve cash flow and reduce write-offs.

PREVENT, PREVENT, PREVENT

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X Administrative Denials: Report and Trend

Review Denials by Payer to

Identify Trends – Payers

Interpret ANSI Reason Codes

Differently

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Administrative Denials

Drill Into Administrative Type Denials to Determine Root Cause and Implement Preventative Measures

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Administrative Denials

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Without technology…paper, time and work effort are wasted

in manual processesTechnology allows for denial capture, denial workflow,

denial inventory management, and in some cases easy access to key documents a follow-up staff member would need. Denials will not go away and resubmission/appeals need to be done timely (or they may result in write-offs)

RECOVER, RECOVER, RECOVER

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X Automate Denial Workflow

• Full/Line ID & Queuing

• Flexible Worklist Set-up

• Easy Access to Key Documents

• Inventory Reporting & Dashboard

• Tracking• Comment Upload

ID

Queue

ReviewResolve

Collect

. .

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System Benefits – Quadax

Automatic Delineation of Full and Partial Denials

•No more reliance on manual remit copies to identify line item denials

Immediate Assignment of Error Category Groupings

•Use (denial) error category groupings for efficient workflow set-ups

Immediate Denial Notification When 835 Received

•Eliminate Reliance on Posting Process

•Eliminate Manual Poring Through ATB to Identify Denials

Reduce black holes and

inadvertent write-offs

Increase staffing efficiencies and

encourage process

improvement

Huge paper and time saver –

decrease days in A/R

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X Automated Access to Key Info

All data available with a click of a button: EOB’s, Appeal Letters, Claim… . .

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X Management Inventory Insight

No more manual compilation of management reports – many available . .

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X How Can Denial Automation Benefit Your Organization?

Decrease Overall A/R: Quickly identify both full and partial denials and route them to users with

best skill sets to work them Provide easy access to key denial source documents for follow-up

users

Decrease Costs to Work Denials Improve staff efficiency in working denials by setting up default orders

within worklists to group similar types denials

Increase Visibility of Denial Aging Inventory Utilize management dashboard reporting to target key denial inventory

issues