Appeals Processing

HomeAppeals Processing

Do you know a lot of revenue is lost every year by practices as denied claims are not appealed? Denial management and appeals processing are integrated processes and cover a major part of claims processing and reimbursements. Our expert led team follows up closely with patients and insurance companies on a regular basis and proceeds for specific set of appropriate action steps based on their input. Filing an appeal as soon as a denial is received can jump-start the extensive process and refine the chances of a timely billing cycle.  Effectively managing of denials by trained staff can highly assist in streamlining a healthcare provider’s financial health. Our team is well versed with procedures and guidelines for recovering the receivables from medicare, medicaid, workers compensation, and attorneys which gives us competitive leverage over other providers.

Appeals Processing Services Process

Filing a claim: A claim is usually considered as a request for coverage. Health care providers will file a claim to get reimbursed for the costs of treatment or services.

The health plan gets denied: The insurance companies must notify healthcare professional in writing and explain why:

  • within 15 days if you’re seeking prior authorization for treatment.
  • within 30 days for medical services already received.
  • within 72 hours for urgent care cases.

Filing an internal appeal after the claim is denied by the insurance companies.

Why choose QWay for Appeals Processing services?

Using a strategy for Appeals: Most of the time it is so, that the healthcare provider is unable to appeal on every denied claim. Focusing on the high dollar value claims and leaving out claims of smaller denominations may have a potential chance of reimbursement after appeal. At QWay HealthCare we devise an appeals strategy that is sure to deliver results.

Categorizing and Tracking Denials: We categorize denial by type/person.  This methodology helps us identify patterns in denials and enables us to streamline the process.

A strong Appeal letter: Using a standard template to draft an appeal letter may not be a wise thing to do. We customize every appeal letter based on the type of denial. While we take all the necessary precaution to include important details we quote industry guidelines, CMS and CPT guidelines and the payer’s reimbursement guidelines to give the appeal a higher likelihood for clearance.

Appeals Processing at QWay is done just the right way, at the right time and with the right documents and only for the claims deemed fit.

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