Laboratories

Denials & Appeals Management

An Appeals Strategy to Increase Revenue and Decrease Denials

With the right appeals solution, denials can be successfully overturned and revenue once thought to be lost can be recovered. According to an estimate by the Medical Group Management Association (MGMA), approximately 65% of claim denials are never appealed. This represents a significant area of opportunity. At Quadax, our Denials and Appeals Management Solutions can execute targeted appeals to maximize reimbursement and capture denial reasons to provide insight into denial trends. You can defend the payments you deserve, get ahead of changing payer requirements, and influence payers’ toward ongoing acceptance of your tests. Our solutions result in fewer denials.

Denials and Appeals Automation that Delivers Results

The best denial management strategy solves for future denials as well as the recovery of reimbursement. Our solutions help you apply insights to immediately improve initial claim processing and defend the reimbursement you deserve. With configurable workflow and intelligent automation, Quadax appeals solutions are scalable to fit your unique needs.

Identify and Monitor

 

Capture, categorize, and report line-level denial data to feed analytics and improve the claim process for fewer future denials.

Never Miss a Deadline

 

Meet timely filing deadlines for appeals with system-generated alerts. Gain the flexibility to prioritize your workflows by appeal deadlines, denial reasons, and payers. Streamline your appeals process to save valuable time and effort while maximizing reimbursement opportunities.

Automate Your Strategic Response

Automate appropriate appeals packages to target various denial reasons (e.g.: medical necessity, out of network, UCR, low pay) for each test performed. Allow for manual review and intervention, as needed, when appeals need to include clinical information or other customization.

Take Action

 

Uncover clear actionable insight using robust reporting analytic tools. Leverage data captured, allowing your team to apply strategies for process improvement and payer negotiations.

Maintain Control of Your Appeals

Access a complete online history of appeals packages. Easily retrieve and maintain supporting documentation via a comprehensive appeals materials library and our integrated document management solution.

Track Recovered Reimbursement

Gain visibility into your appeals strategy success rate. Given the long lag time from initial claim to final appeal determination, it is important to determine if payment was a result of the original claim, an appeal, or a patient statement. Our solution provides insight into the cause-effect relationship.

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