August 2009 Newsletter
Denial Management X Workflow: Tools for Effectively Managing Your Denials
Providers have long struggled with managing the increasing volume of denials within their organizations. Issues inherent in this struggle include accurate and timely identification and routing of incoming denials, managing denial inventory to ensure timely response, and collecting data for denial analysis. While mainframe systems may help provide insight into zero payments and denial write-offs, they are often limited in their ability to effectively categorize denials for analysis purposes, route denials quickly to specific follow-up staff, and provide clear visibility to the subset of aging denial inventory.
In response to this need, Quadax has been working to design new functionality that helps our clients better manage denials. At this year’s user conference, Quadax introduced the first of three new Denial ManagementX(DMX) modules - DM X Basic Reporting. Providers who have begun using this module are reporting that the data generated by the DMX Basic Reporting module has been an eye-opener on the true volume of denials hitting their organization.
Now that the volume of denials is clearly visible, providers are looking for ways to more effectively organize and follow up on this population of denied accounts. Quadax has been working with a core set of client beta partners to refine the second DMX module and is proud to announce the upcoming roll-out of the DMX Workflow module.
Introducing DMX Workflow Module
DMX Workflow is designed to give you the tools you need to:
- Quickly identify both full denials and line item (partial) denials
- Automatically route those denials based on payer/denial type/total charges, etc. to the appropriate follow-up staff based on customized rules for your organization
- Provide easy access to key working documents in one system (denied EOB, 835 info report, and originally submitted claim)
- Monitor denied inventory to ensure that your staff is responding to payer denial in a timely fashion
Denial Identification
When we first sat down with our client beta partners to talk about how denials were currently identified for follow-up, we began recognizing the following trends across the provider base:
- Notification of the denial for follow-up was generally dependent on the remit file being posted into the mainframe system. This dependency could result in delays of up to two weeks for follow-up staff to commence initial follow-up activity.
- Denials were generally not tagged in a way that classified them into different follow-up groupings; follow-up staff had to individually look at each denial to determine what type of follow-up work was needed.
- Some providers could generate a daily list of denials for distribution among their follow-up staff, but did not have the ability to make this list cumulative to show the denials that had not yet been worked from prior days. If the denial was not worked off the daily denial list, follow-up staff would probably not work the account until it hit a critical aging bucket and appeared on another report (i.e., ATB).
- In almost all cases, there was no automated process in place to identify line item (partial) denials. Generally follow-up staff was combing manually through paid sections of remits to identify cases of line item denials or finding them at a later date buried on their ATBs with an active insurance balance remaining.
Quadax took all these findings into consideration when developing the DMX Workflow module.
- Denial notification is no longer dependent on cash posting; the 835 denial is available immediately in workflow when it is received by Quadax.
- Denials are also automatically categorized using broad error categories (eligibility, authorization, coding, etc.) so that providers can use this information for more effective routing and organizing of follow-up work.
- All denials stay on views (work lists) until work has been completed to respond appropriately to the denial.
- Most notably, DMX Workflow automatically identifies line item denials and allows providers to choose whether they would like them worked in aggregate along with full denials or have them segregated out to be worked by a specialized variance team.
Denial Routing
Our beta partners ranged significantly in their preference on routing denials within the organization. Some partners preferred a more traditional approach and chose to split follow-up work by payer exclusively within the business office. Others preferred to route work automatically to different departments of the organization and push the follow-up on a denial closer to its point of origin.
Quadax recognized through this feedback that flexibility was critical. As a result, DMX Workflow has been designed to incorporate information from additional fields (that are not part of standard claim data) to be used as criteria in the work list rule-building engine. We have enhanced the Advanced Workflow interface to include fields such as EOB payer, denial error category, denial error, department, financial class, and plan code that can all be used as criteria for automatically assigning workflow statuses and ultimately setting up customized views for different follow-up areas.
Once views have been set up, providers have the ability to set a default order to group all denial types together by payer to maximize efficiency of the follow-up work. For example, a view can be default ordered to display all eligibility denials together, all authorization denials together, all coding denials together, etc. so that the person working the denials does not continually have to switch from one denial type to the next and can more efficiently approach the workload for the day.
Easy Access to Source Documents
A key piece of feedback that we received from beta partners was that they needed easy access to the denial source documents, primarily the denied EOB housed within one system. Quadax has redesigned the Selector interface for DMX Workflow to provide quick access to the EOB and/or 835 info report for line item details through a link in the title bar. All key source data is now maintained within one consolidated system to further increase the efficiency of follow-up staff.
Management Inventory Reporting
Monitoring the inventory of open denials was expressed by many of our client beta partners as a challenge. Denials generally were buried within ATB reports, and there were no further tools available to make denials and their associated denial aging easily visible for monitoring purposes.
Quadax has specifically designed expanded management reporting tools within the DMX Workflow module so that providers can easily see where their active denial inventory is sitting and how old it is from the original date of denial. This reporting is intended to increase the visibility of the organization’s denial inventory, specifically as it relates to monitoring specific payer deadlines for denial response.
Release of DMX Workflow Module
Quadax is still in active beta testing for the DMX Workflow module and is anticipating an initial release date in the fall of this year.
To learn more about DMX Workflow module by Quadax, contact Kerry Elledge.
Denial ManagementX by Quadax is one part of Xpeditor Xtensions— the premier system for better bottom-line results in your healthcare business office.