Denials Management

The Artiva Healthcare Patient Financials – Insurance module is designed specifically for commercial and governmental insurance follow-up. It establishes and tracks payer promises, captures and reports denial statistics, creates management-defined work queues, and uses look-ahead features to gain the most from each payer contact. It also works individual payers and self-pay patient responsibility in parallel. It’s a solution that allows you to integrate various departments in the revenue cycle, manage denials and reduce days outstanding very efficiently and cost-effectively.

The Denial Management features of the Patient Financials – Insurance module do more than just capture payer denials. It helps you respond to them and record payer trends as well. The Denial Management solution empowers providers to easily input their denials business rules and triggers Artiva Healthcare’s workflow engine to process the denial files and build exception worklists.

The Denial Management solution will:

• Capture, trend and respond to payer denials ensuring prompt response and quick problem resolution.
• As rejections are captured, trigger workflow to automate the management-defined response and log appropriate payer statistics for trending reports
• Receive data from various sources: HIPAA EDI 835, phone, paper
• The optional Intersystems Ensemble platform can be leveraged to integrate the 835 content into the denials statistics.

Consequently you get more than quick problem resolution and the data you need for denial/rejection/appeal follow up; you get a holistic, more informed view of payer denials.

The Claim Status features do more than just capture payer claims. It helps you respond to them and record payer trends as well. As claim status data are captured, they trigger the module’s workflow engine to process the claim status files, build exception worklists and log appropriate payer statistics. Payer-specific claim status codes are then mapped to ensure consistent interpretation across payers.