Rejection Handling Services

Rejection of medical claims is one of the most common challenges healthcare providers face in the revenue cycle. Claim rejections can delay payments, disrupt cash flow, and create an unnecessary administrative burden. At Advantawise, we specialize in claim rejection handling, ensuring that rejected claims are promptly addressed, corrected, and resubmitted to ensure a seamless reimbursement process.

The Challenge :

Medical claims rejections can occur for a variety of reasons, each of which can hinder your practice's revenue cycle:

• Incorrect Information: Common errors include incorrect patient details, missing or inaccurate codes, or invalid insurance information.
• Missing Documentation: A claim may be rejected due to missing supporting documentation such as pre-authorizations, referrals, or signatures.
• Coding Errors: Mistakes in ICD, CPT, or HCPCS codes are frequent causes of claim rejections, affecting reimbursement and compliance.
• Payer-specific Requirements: Different payers have different criteria and requirements for processing claims. Not adhering to these can lead to rejections.
• Time Constraints: Rejected claims require quick attention to prevent payment delays. Without a dedicated team, your practice might struggle to resolve rejections promptly, leading to extended AR days.

Our Solution :

At Advantawise, we provide comprehensive Rejection Handling Services designed to quickly address and resolve the issues behind claim rejections. Our team of experienced professionals works tirelessly to ensure that rejected claims are corrected, resubmitted, and processed successfully.

• Thorough Rejection Analysis: We begin by carefully analyzing rejected claims to identify the specific reasons behind the rejection, such as missing information or errors in coding, ensuring we don’t miss any crucial details.
• Efficient Resolution of Errors: Once the rejection reason is identified, our team takes immediate action to correct any errors. This may involve fixing coding issues, updating patient information, or gathering necessary documentation to resubmit the claim correctly.
• Prompt Resubmission: After making the necessary corrections, we resubmit the claim to the payer as quickly as possible, reducing delays in the payment process and improving your cash flow.
• Comprehensive Documentation Review: Our rejection handling service also involves verifying all the supporting documentation required by the payer to ensure that nothing is left out. This prevents future rejections related to missing or incomplete documentation.
• Ongoing Monitoring & Follow-Up: We don’t just submit and forget. We continually monitor the status of your claims and follow up with payers to ensure that they are processed promptly, keeping you informed every step of the way.