Problem Statement

Payer denials require staff to research each account, gather supporting information, and rework or appeal the claim before timely-filing deadlines pass; because the large majority of denials are avoidable and every unworked account risks becoming a write-off, this manual follow-up is a direct, ongoing drain on recoverable revenue. Eligibility denials are among the most recoverable of all: a CO26 (services before coverage began) or CO27 (services after coverage ended) usually means the coverage effective or termination dates, or the filing order, are wrong on the account rather than that the patient truly lacked coverage. Resolving each one manually means verifying the correct dates and order and resubmitting to the right payer, repetitive correction work that nonetheless has to happen before the filing window closes.

Automation Solution

This automation reviews eligibility denials (CO26 and CO27), updates the coverage effective and termination dates and filing order as needed, and resubmits the claim to the correct payer.