Denial Management
Utilizing proprietary workflow software, Apollo Health Street retrieves and interprets denial information, reviews HIM documentation, and prepares compelling appeal packages for review by the payer. Our web-based technology sorts, refines, and evaluates denial details from 835s, paper EOBs, and correspondence. The adhoc reports generated by this technology are exportable to basic desktop applications. Apollo loads accounts into a proprietary system for timely and accurate workflow tracking and segmentation into clinical and technical denial categories. Apollo’s skilled clinicians will review medical records on clinical denials to complete appeals. Once we appeal the account, our dedicated follow-up team confirms receipt of the appeal, and demands claim disposition as quickly as possible to ensure that applicable contractual timelines are met. Apollo will forward technical denials to the clinical appeal team for medical necessity review and appeal, when warranted.
Apollo will establish pre- and post-intervention comparisons of hospital’s appeals, denials, and account dispositions, in order to measure performance and to help define the value of this contingency-fee service. We offer an assessment before the Denial Management implementation begins to help the hospital maximize the benefit from this service. In addition, Apollo will form an interdisciplinary team with the hospital to ensure development of sustainable best practices.
Key features and benefits of our solution:
- Easily exportable reports
- Timely and accurate workflow tracking
- Pre-implementation assessment to maximize benefits
- Billed A/R over 90 days ratio
Service line deliverables:
- Denial assessment
- Root cause analysis
- Clinical and technical appeals
- Process re-engineering
- Comprehensive management reporting
- Payer behaviors trended to increase contract negotiating power