Problem Statement

Some payers review only the first-listed specialty when adjudicating a claim, so inpatient Evaluation and Management (E&M) services for multi-specialty, same-day visits are denied incorrectly; especially when multiple specialists see the patient on the same day. Staff must judge whether each denial is worth appealing or should be written off, a manual, case-by-case review that is labor-intensive and, if mishandled, surrenders legitimate revenue as a denial write-off.

Automation Solution

This automation reviews these multi-specialty same-day E&M denials, determines whether each is appropriate, and either submits an appeal or writes off the balance based on appeal merit, ensuring accurate follow-up while reducing manual work.