The cost to appeal is worth the claim reimbursement and modification of payer behavior. As we approach 2022, one of our new year’s resolutions should be to do what’s necessary to decrease denials. We know that payers and external auditors took a break during the pandemic, but now it’s open season for audits and denials. […]
Providers and payers are increasingly adopting electronic claims management transactions, but remittance advice and prior authorizations are still largely manual. Electronic claims management adoption by plans and providers is at or above 80 percent for three of the seven transactions analyzed in the most recent CAQH Index. The CAQH 2018 Index showed adoption of fully electronic […]