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. Many COB denials can be resolved by re-checking the patient's coverage directly: running real-time eligibility surfaces the current active coverage and filing order, which can then be corrected on the account, with a patient letter sent only when eligibility can't supply the answer. Working each denial through that sequence manually is repetitive and time-sensitive.

Automation Solution

This automation reviews Coordination of Benefits denials, runs Real Time Eligibility to confirm coverage, updates coverage and filing order as needed, and sends a patient letter when required, then resubmits the claim to the correct payer.