Medical billing denials: 5 steps

STEP 1: REVIEW

To handle a denial, first, grasp the reason. Look for the denial code from the insurer's explanation. Understand before proceeding.

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STEP 2: REVISE

After understanding the denial reason, correct any errors and include missing info. Ensure thoroughness for better claim understanding.

STEP 3: REQUEST APPEAL

After understanding and fixing errors, proceed with appeal: internal (with insurer) or external (third-party review).

STEP 4: REACH AGREEMENT

After appeal submission, await insurer's review. If accepted, great! If not, revise and repeat. Communication may take time.

STEP 5: REINSTITUE PREVENTATIVE PROCESSES

Handle denials proactively: review claims, identify mistakes, fix processes. Reduce denials, boost revenue.

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