ReSolve® Denial Management

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

RCMS ReSolve® Denial Management can quickly isolate medical claim denials/defects and help to prevent 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 third-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 productivity reports to identify those efforts that resulted in payment. Lag times between follow-up and collections 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 payer websites, document imaging, EMR and PM systems
  • Reporting and data analytics for permanent revenue cycle improvements

ReSolve® Modules

Patient Access | Correspondence Management | Payment Processing | Bank Reconciliation | Denial Management | A/R Collections | Reporting & Analytics

ReSolve® is a registered trademark with the United States Patent and Trademark Office (USPTO). OnBase® is a registered trademark Hyland Software, Inc.