ReSolve® Denial Management

RCMS ReSolve® Automatically Captures Denials and Claim Defects for Effective Routing and Follow Up. Detailed Trend Analysis Reduces Future Occurrences by Identifying Root Causes of Most Denials

Denial Management Improvements

RCMS ReSolve® Denial Management solutions quickly isolates medical claim denials/defects and prevents future re-occurrences. Working in tandem with our Payment Processing application, denied claims are automatically captured and routed to the appropriate individuals, facilitating timely and effective follow-up with 3rd party payers. This increases cash flow and decreases process delays.

Identifying the Root Cause of Denials

Denial trends can be analyzed and traced to specific areas — from patient access and eligibility to individual physicians, departments and type of service. By identifying the source of each denied claim, Denial Management allows staff to resolve the root cause of denials, thereby reducing the initial denial rate of future claims and providing a true process improvement solution. 

ReSolve® Denial Management automatically captures denials and routes them to appropriate work queues for timely follow-up. By identifying and tracking the root cause of denials, true process improvements are realized.

ReSolve® Denial Management reduces cost-to-collect through powerful workflow tools. We track KPIs, such as AR Days, with dynamic drill-down reporting and charting tools for status, trending, productivity and much more. The application tracks the complete cycle of denial management and generates reports to identify efforts that resulted in payment. Lag times between follow up and resolution are also documented, providing valuable information for contract re-negotiations.

ReSolve® Denial Management Benefits

  • Automated routing of delay and denial exceptions to collectors
  • Normalized reporting and workflow across disparate billing systems
  • Automated account follow-up activities and reduced cost to collect
  • Data synchronization with host billing system(s) for adjustments, transfers, remarks and comments
  • Integration with payor websites, document imaging and Electronic Medical Records (EMR)
  • Reporting and data analytics for permanent revenue cycle improvements

RCMS Healthcare Provider Solutions:

Patient Access | Correspondence Management | Follow Up & Collections | Payment Processing | Bank Reconciliation | Denial Management | Reporting & Analytics

ECM for Denial Management

RCMS provides for hosted or on-site Enterprise Content Management (ECM) that provides staff with quick access to indexed, searchable documents in all formats. Contact RCMS to learn more about our ECM Document Management Solutions that can improve Denial Management workflow processes for your Health System, Hospital or Practice Group.