Denial Management
Optimize Revenue with Expert Denial Management Solutions.
At SkyShine Health Solutions, our Denial Management Services are designed to minimize claim denials, recover lost revenue, and optimize your practice’s financial performance. As a leading medical billing company, we help solo practitioners, multi-specialty clinics, and large healthcare facilities tackle the complexities of claim denials with precision and efficiency. Using advanced analytics, proactive strategies, and industry expertise, we ensure your practice collects every dollar owed while reducing administrative burdens.
Claim denials can significantly impact your practice’s cash flow, with up to 20% of claims denied due to coding errors, eligibility issues, or payer policy changes. Unresolved denials lead to lost revenue, increased AR days, and wasted staff time. Our denial management services identify, resolve, and prevent denials, ensuring a healthy revenue cycle and improved financial outcomes.e
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Our Denial Management Services
Root Cause Analysis
We dive deep into denial data to identify patterns and prevent recurring issues.
What We Analyze:
Coding errors (ICD-10, CPT, HCPCS)
Eligibility and authorization issues
Payer-specific policy violations
Our detailed analysis reduces denial rates by up to 30% by addressing underlying causes.
Denial Resolution and Appeals
Our expert team efficiently resolves denied claims and submits appeals to recover payments.
Our Process:
Review denial reasons and payer correspondence
Prepare and submit compliant appeals with supporting documentation
Track appeal status for timely resolution
We achieve a 90% success rate on appeals, recovering millions in denied revenue for our clients.
Proactive Denial Prevention
We implement strategies to stop denials before they occur, ensuring clean claims and faster reimbursements.
Prevention Strategies:
Pre-submission claim scrubbing for accuracy
Real-time eligibility verification integration
Staff training on payer policies and coding standards
Our proactive approach boosts clean claims rates to 98%.
Payer-Specific Expertise
We navigate the unique requirements of all major payers to ensure compliance and maximize recoveries.
Supported Payers:
Payer Type | Examples |
|---|---|
Government | Medicare, Medicaid, Tricare |
Commercial | Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield |
Regional | Local HMOs, PPOs, and specialty plans |
Our team stays updated on payer policy changes to keep your claims compliant.
Analytics and Reporting
Our advanced analytics dashboard provides real-time insights into denial trends and recovery performance.
Reports Include:
Denial rate by payer, provider, and reason
Appeal success metrics and recovery amounts
Actionable recommendations for process improvement
These insights empower your practice to optimize operations and reduce future denials.
Lets experience our medical billing services
Over 500+ medical practices trust Skyshine Health Solutions medical billing services company. So let’s have a chat.
Patient's insurance coverage verification on the spot.
HIPAA-compliant medical billing services for data safety.
24/7 medical billing services to handle every claim submission.
98% claim reimbursement rate for healthy cash flow.
Why You Should Choose Us?
Our medical billing experts dive deep into your healthcare RCM procedures with the aim of earning clients’ satisfaction as a result. With this vision, we offer the most cost-effective, highly efficient and reliable medical billing solutions to our clients.
From patient eligibility verification to claim submission, our expert medical billing specialists pay attention to fine details in practice management. We make sure that your hard-earned income never slips through the loopholes.
We empower healthcare practices with robust support and insightful medical billing services. We ensure 100% accuracy through our professional healthcare RCM services to claim payments. We boost revenue with precise, efficient billing services.