Did you know that, on average, up to 20% of all healthcare claims are initially denied, leaving healthcare organizations to review, analyze, rectify errors, and fight for reimbursement? Complex processes have made claims denial management increasingly difficult, causing revenue leakage, disrupting cash flow, and creating administrative hurdles. Healthcare organizations find it overwhelming to implement long-term process changes and deploy in-house teams effectively to prevent denials.
With over 24+ years of expertise in Healthcare Back-office Support Services, Suma Soft's denial management services offer a solution-based approach that involves identifying, analyzing, and resolving claim denials to improve revenue cycle performance and protect against financial setbacks. Our denial management services experts streamline workflows, minimize payment delays, analyze trends, identify root causes, and implement proactive strategies to prevent future claim denials. Our effective denial management services ensure reduced claim rejections, boost revenue growth, and stabilize your organization’s financial future!
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70% Reduction in operational costs
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80% Improvement in productivity
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50% Reduction in aged accounts receivables
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90% Improved net collections
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78% Decrease in denial rate
Suma Soft’s denial management services are designed to streamline your revenue cycle and decrease claim denials significantly. With a wide range of services for denial management in medical billing, Our skilled and qualified denial management experts tackle every aspect of the denial management process to improve your Revenue Cycle Management (RCM). Our diverse medical accounts receivable services assist healthcare organizations in achieving operational and financial goals by effectively and efficiently managing every claim and delivering top-quality services that meet your specific needs:
Patient Eligibility Verification
Our advanced denial management services verify eligibility in real-time, minimizing delays and denials and ensuring patients' insurance coverage and benefits are confirmed before their visit.
Prior Authorization Management
We monitor prior authorization requirements for patient visits, preventing unnecessary complications. Our denial management service team streamlines the authorization process, ensuring all necessary approvals are obtained upfront.
Accurate Medical Coding and Claim Submission
Our certified coding professionals accurately review and verify claim codes before submission and ensure best practices comply with industry standards, minimizing denial risks. Our denial management service team ensures all codes are error-free, especially while transitioning to ICD-10.
Medical Necessity Determination
Now, prevent your claims from being denied due to unsupported diagnosis codes. Our denial management services leverage advanced technology to ensure alignment with insurance coverage policies on medical necessity with our detailed information about medical policies from all major insurers.
Denial Management and Appeals
Our denial management service experts track and analyze denied claims, pinpoint root causes, develop targeted solutions, and prepare strong appeal letters. From clinical documentation submission, follow-up with payers, and escalation when needed, we ensure claims are processed correctly and promptly through an entire appeals process.
Continuous Process Improvement
We analyze the root causes of denial, address recurring issues, and improve the efficiency of your revenue cycle. Our denial management services implement processes based on denial trends and payer feedback, optimizing future claim submissions and minimizing denial risks.
Training and Education
We empower your team with the knowledge and tactics to prevent errors, enhance efficiency, and improve claim accuracy. Our denial management service experts train your staff and providers about the latest coding practices, authorization requirements, and payer policies.
When it comes to maximizing reimbursements, we understand that every healthcare organization is unique, so each denied claim is also unique. Our denial management services follow a systematic, solution-based approach to ensure each claim receives the attention it needs to be resolved quickly while adhering to market guidelines and defined best practices. Suma Soft's streamlined denial management process ensures that every denial is addressed effectively, delivering maximum results and improved and smooth collections.
Denial Identification
Our denial management services identify denied claims early on by leveraging advanced analytics and reporting tools to address issues before they escalate.
Root Cause Analysis
Whether it's a coding error, missing clinical documentation, or compliance issues with payer guidelines, our denial management service team accurately analyzes each denied claim to understand the root cause.
Appeal Preparation
We carefully prepare and submit appeal letters, providing clear and concise explanations, along with supporting clinical documentation, to justify the claim and secure payment.
Payer Follow-up
Our denial management team proactively follows up with payers to ensure swift and smooth appeal processing and address any questions, issues, or concerns.
Continuous Monitoring and
Improvement
By consistently monitoring denial trends, analyzing denial data, and identifying opportunities for process improvement, our denial management team implements strategies to prevent future denials and optimize lost revenue recovery.
With optimized processes, skilled experts with market knowledge, and advanced technology, our denial management services reduce the number of denials by identifying the root causes and implementing necessary preventive measures to resolve denied claims swiftly, improving your bottom line. Partner with Suma Soft to experience the following benefits:
Reduced Denial Rates
By identifying and resolving causes of denial claims, our denial management services ensure a significant reduction in denial rates.
Improved Cash Flow
By accelerating the resolution of denied claims, our denial management services help improve your cash flow and financial stability.
Enhanced Revenue Cycle Efficiency
Our streamlined denial management process not only optimizes your revenue cycle but also reduces administrative burdens and increases productivity.
Data-Driven Insights
With a data-driven approach, our denial management services provide valuable insights into your denial trends, empowering healthcare organizations to make informed decisions and take proactive measures.
Compliance Expertise
Our denial management service team stays up-to-date with the latest regulations and guidelines to ensure compliance and avoid penalties.
Dedicated Support
Access exceptional customer service and support throughout the denial management process with our team of experts.
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