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. Some COB denials can't be fixed from internal data alone, because the payer needs current coordination-of-benefits information that only the patient can supply, such as whether other coverage exists and which is primary. Until that information is gathered, the claim stays denied, so the patient has to be contacted promptly, and generating each outreach letter manually is slow and easy to defer.

Automation Solution

This automation generates and sends Coordination of Benefits (COB) denial patient letters using Epic templates to gather the missing coverage information after receipt of a COB denial.