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Claim Denials Prevention

Stop the number one cause of revenue leakage.
Start preventing denials before they happen.
Charges and Denials Summary
Charges and Denials Summary
Denials List
Charges and Denials Summary
Charges Summary
Validations Summary by Alarm Type
Validations Summary by Alarm Type
Validations Summary by Alarm Type
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Data Entry Errors
The majority of claims are denied because of simple typos. Misspelled names, transposed numbers and incorrect gender can cost healthcare organizations tens of thousands of dollars a year.
Coding Errors
Coding errors are some of the most common reasons for denied claims. Errors can occur simply because software has not been updated to new coding rules. However, they often happen because of invalid code and modifier combinations, lack of specificity and procedures deemed not medically necessary because of diagnosis coding.
Ineligible Services
Insurance coverage changes. Eligibility checks and insurance verification are often not completed, and information is no longer accurate, leading to denied claims that may not recoverable.
Billing and Timely Filing Errors
Billing and timely filing errors account for another large portion of claim denials. These issues arise from missed deadlines, omitted information and duplicate claims.
Missing Authorizations
Denials for authorization do not mean a provided service is not eligible for coverage. Usually, the authorization either was not obtained before the encounter or the proper documentation was not linked or attached to the claim.
Prior Authorization Required (Referrals)
Some payers require a physician authorization or referral in order to verify the medical necessity of a specialty visit. These denials are easily avoidable and can impact patient satisfaction when the encounter is not covered.
Healthcare revenue cycle management (RCM) involves the financial process of managing claims, payment, and revenue generation in healthcare organizations. Claim denials are a significant challenge within this process and can impede cash flow, increase administrative burden, and affect overall financial performance.
Tell us your top denials to customize the tool your team needs to prevent them!
Your Challenges

Your Challenge

Our Solution Main Features

Flexible Rules Engine
Alarm all your top denials by setting relevant rules to monitor information, follow-up on exceptions and confirm problem resolution before claims submission.
Root Cause Analysis
Our drill down feature gets to the root causes of denials, so you can accurately identify when and where corrective actions need to be taken.
Actionable Analytics
Actionable real-time analytic reporting allows you and your team to fully adapt the tool to your needs. As your requirements evolve, the tool can be modified to any new reporting configuration.
Main Features

Empower your denial management team and reduce your denial rate at least 50% with the next generation of Healthcare RCM software.

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Starting within the Revenue Cycle, work on Payer Profiling and Claim Denials root cause analysis.

In addition to quickly boosting revenue and delivering a swift return on investment,

Effy Healthcare offers benefits such as:

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  • Reduced and eliminated denials

  • Lower days in A/R

  • Higher payer and patient collections

  • Decreased manual workloads

  • Easy-to-use performance reporting and analytics

  • A sustainable program to continually improve efficiency

Key Figures
Business Meeting
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