Denial Management



Identify Denial Reason Codes and Correlate to Standard Actions

Every denial has specific reason for non-payment.  Once the denial cause is identified, our team will correlate the cause to the appropriate action.  For efficiency, actions are standardized and followed accordingly.

Correct & Resubmit

For resolving minor errors, a simple correction is all that is needed.  The data is corrected and the claim is re-submitted.

Sometimes however, correction could involve sending supporting documents, inquiring client for additional information or clarification, and research.  All actions are documented as notes in patient accounts for tracking purposes.

Effective Appeals

If the claim is denied despite correct and complete data, we will appeal to the insurance company.  We have prepared standard appeal forms for effective response.

Timely Follow-up

As receivables get older, there are less chances of getting it collected. Hence we are committed to keep receivables as low as 45 days.

Resource planning is done to ensure that all the unpaid claims are being followed up within pre-defined time frame. 
  • Resource planning is done to ensure that all the unpaid claims are being followed up within pre-defined time frame. 
  • A Pending Charge reports is generated on a regular basis to identify payments that have not yet been paid.
  • EOBs are scrutinized for payments of previous corrections / appeals.
  • Insurance companies are contacted to verify receipt of appeals and follow-up.


Denial Analysis

There are specific causes for the accumulation of the denied receivables.  Denial Analysis will provide the characteristics of the denials, to get it resolved from the root.

Financial Impact Analysis

Analyzing the financial impact of the Denials is very crucial.  Our team will identify the general pattern and stake of the denials to evaluate its impact on financial returns.

Results lead to improvement in performance and overall process

The results of the Root-Cause Analysis and Financial Impact Analysis will provide feedback to improve the efficiency in all phases of revenue cycle management.

  • "We have been working with Fedora Solutions for almost two years now. I must say they have been a tremendous help in working with our numerous accounts. Since they have been working with us we have been able to remain timely with our patient's accounts. I want to thank all staff members for their hard work and the many hours they have put into helping us." - Evelyn Rangel
    Account Rep
  • "I have been working with Fedora Solutions staff for the last couple of years and they have been a big help with our billing and any question we have. They are quick to respond by email or phone and they are always willing to help in anyway they can and a pleasure to work with."- Tammie Ambriz
    Insurance Supervisor
  • "It has been a great pleasure to work with Fedora Solutions for the last two years.  They have learned every aspect of our billing department and have been a tremendous help in keeping our business current.  They have taken on everything we have given them & helped keep pace with our expanding practice."- Sandra Wheeler
    Payment Coordinator
  • "It has been my pleasure to work closely with staff at Fedora for several years. The staff and Fedora are friendly and has been a great asset to our companys success. The staff at Fedora are extremely knowledgeable and are quick to solve problems such as coding and billing issues and the appeals process in the event a claim has been denied. I look forward to many more years working with Fedora and their highly trained staff."- Cynthia Hukill
    Account Rep