Problem Statement

When payers issue additional documentation requests (ADRs) on denied claims, staff must manually pull the supporting medical records and upload them through the payer portal. This is a high-volume, time-sensitive task, and submissions that lag or miss the deadline leave the claim unpaid and aging. Because payers typically pay once the additional information is provided, handling these requests accelerates cash and improves aging accounts receivable.

Automation Solution

This automation compiles the medical records tied to each Blue Cross Blue Shield documentation request and uploads them to Availity, satisfying the ADR so the claim can be paid without manual handling.