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Denial management helps you get paid faster by giving you the tools you need to individually resolve, as well as, address the root cause of your denials and rejections. You can automatically flag denials that require review, efficiently resolve denials and resubmit insurance claims, and identify and address the root causes of your denials. By systematically rooting out your denials, you'll get paid faster and save time.

Flag Denials and Rejections Automatically

Once you submit your electronic claims, Kareo's clearinghouse service checks the format of your electronic claims for any missing information and validates your electronic claims against various payer-specific formatting requirements. If there are any problems with your electronic claims, you will receive a claim processing report that provides a list of rejections that must be resolved before your claims can be forwarded on to the government payer or commercial insurance company. Kareo will then change the status of your claims to "Rejected", and as a result, automatically categorize your rejected claims for correction and resubmission.

After your electronic claims are forwarded on to the government or commercial insurance company, they will be reviewed and adjudicated for payment by the payer. If you have enrolled with Kareo for electronic remittance advice services, you will then receive an electronic remittance advice report back from the payer that provides details about payments and any denials. Those denials may occur for various reasons, such as the patient lacks insurance coverage for certain medical services, or the services were not deemed medically necessary. Any time you receive a denial, Kareo will then change the status of your claims to "Denied", and as a result, automatically categorize your denied claims for correction and resubmission.

Resolve Denials and Rejections Efficiently

Since Kareo categorizes your insurance claims as "Rejected" or "Denied", your insurance claims are automatically organized into a work list of rejections and denials. For each rejection or denial, you'll see information about the insurance claims and a rejection or denial message. Simply drill-down into the affected insurance claim to correct and resubmit the claim. After each insurance claims claim has been resubmitted, it will be automatically removed from your work list. It's really that simple!

Address Root Causes of Denials and Rejections

Even though Kareo makes it easy and convenient to identify and resolve your denials and rejections, what you really want to do is address the root causes so you never receive the denials and rejection in the first place. Kareo helps you do this by providing powerful denial management reports that group your denials and rejections by reason and dollar amount, trended over time. This helps you identify frequently recurring denials and rejections that can be addressed through process changes in your practice. For example, if you're routinely receiveing denials because the patient is ineligible for insurance coverage, then you may want to begin verifying each patient's insurance eligibility prior to scheduling appointments.

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