Rejection and Denial Management (A/R Control)

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Eliminate Denials and Rejections. Get paid faster & accurately.

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Do you know 30% of your claims get rejected and/or denied?

Every practitioner knows claim rejections and denials can be tricky & complicated. That’s why it is critical that your claims are submitted clean the very first time. Claim denials can simply disrupt your cashflow. Efficient denial management is the key to effective revenue cycle management.

OmniMD RCM is a tool that provides details about every rejection and denial thereby allowing you to address the root cause of your denials and bring down the denial rate. Billers can easily broadly classify and flag denials that require review and efficiently resolve denials and resubmit insurance claims.

Before a claim is channelized into the payer adjudication system, the claim goes through a multistep validation process. With OmniMD RCM at each step, the rejected and denied claims are automatically categorized and put into separate buckets based on clearinghouse and payer status reports, so you don’t have to necessarily login into clearinghouse or payer portals to verify the status every time.

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Each validation step reviews the claim for not only EDI file formatting rules but also for patient address, service location, CPT-ICD combination, payer ID, LCD and CCI guidelines, etc). If there is missing or invalid information, OmniMD RCM will sort those claims into scrub failed bucket and similarly any rejections and denials by clearinghouse or payer into respective buckets based on claim status and remark and rejection codes.

Supported EDI Standards

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You can run detailed reports on CARC (Claim Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes) to find the root cause of each denied claim and address the root cause. Preventing and reducing errors in your claims is the key to getting paid faster.

  • arrowPrevent denials with embedded and user-configured claim validation engine
  • arrowReal-time claim submission status
  • arrowHot links to identify your lost claims
  • arrowHot links to identify your no response claims
  • arrowHot links to identify your rejected and denied/unpaid claims
  • arrowCreate transparent to-do lists allowing users to quickly identify claims needing attention
  • arrowTrack claim history
  • arrowScript Manager to create automated work queues.
  • arrowRobust reporting to provide insight into your rejections and denials to proactively respond and prevent future denials.
  • arrowBilling Dashboard showing payer denial trends
  • arrowBilling Dashboard showing payment velocity

Click to learn more about OmniMD’s claim submission and management process.

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