ExdionDM- Denial Appeal Letter Generation

Denial Appeal Letter Generation

Prepare and send denied claims appeal Letters using auto-generated templates along with supporting documents.

Automatically generate and file appeal letters to the carriers along with the supporting documents for processing, via phone, fax/email or mail.

Denial Management Made Easy!

About Client

A West coast-based healthcare service provider was facing challenges on the RCM front, especially on
Denial Management. Their service level agreements required them to churn out large number of
insurance claims within a stipulated time.
Substantial amount of resources was utilized for the Denial Management process. However, the client
was facing both soft and hard denials of which about 70% of total denials being preventable. Client was
facing denials due to registration inaccuracies, invalid codes, inappropriate credentialing and other
reasons. About 40% of these denials were never worked in time resulting in an estimated loss of 3%
revenue and cost of reworking a claim was close to $30.

Solution

Traditionally the process was managed by 20 associates. Manual entry process had its
shortcomings: rework, productivity & absenteeism. Denial Management required the data to be
entered in a specific format and supported by an appeal document. Any misgivings here and the
payments were rejected.
ExdionRCM team conducted a process audit to understand the SLAs, workflows and desired
throughput. We suggested standardization of pre-registration information and deployed ExdionDM, a
smart AI led solution and designed a human assisted denial workflow management process.
ExdionDM uses ML models to automatically generate the appropriate appeal forms by auto filling
the relevant information and claim documents from PMS, thus completely eliminating preventable
errors. ExdionDM also stores all the documents in a folder for subsequent review. If there are
exceptions, ExdionDM flags it to the supervisor who can take any corrective actions. Once the
exception is reviewed, ExdionDM learns from the new scenario and readies itself to use the new
chunk of information for future processing.

Benefits

With ExdionDM implementation, the client benefited from both direct and indirect benefits.

Direct Benefits:

  • Reduces Cost 4 FTE released.
  • Inefficiencies of denial.
  • Reduces TAT no late submission.

The major indirect benefits were:

  • Smoother denial management operations.
  • Release of manpower from repetitive work.
  • Increased work satisfaction of employees and less attrition.

 

Contact us

Want to know more? Contact us today for a free trial of the revenue integrity solution developed expressly for acute care centers.