Denial Management Services

Mediculogy specializes in efficient denial management to help healthcare providers recover lost revenue and reduce claim rejections. Our proactive approach identifies root causes, resolves issues promptly, and prevents future denials, ensuring a smoother revenue cycle for your practice.

Denial Management Servies

At Mediculogy, we specialize in providing denial management solutions for claims with a ‘reject/resubmit’ status that have aged beyond 60 to 90 days, yet are not ready to be assigned to collections. We recognize the critical value of recovering these claims, especially when internal resource limitations prevent timely processing.

Despite timely payment regulations in many states, hospitals often struggle to collect on accounts aging beyond 60 days. These claims can become a significant financial burden if not addressed efficiently. Our expert team is dedicated to reducing the weight of uncollectible accounts on your facility’s bottom line, while also offering professional medical billing audit services to ensure long-term revenue cycle improvement.

WHAT SERVICES Mediculogy PROVIDES?

We revisited our approach and returned to the drawing board to develop a more streamlined, efficient, and error-free system for insurance credentialing and credentialing in medical billing. By consolidating all practice, provider, and payer data into one unified platform, complete with reminders, follow-ups, and provider credential management, we guarantee earlier effective dates and expedited reimbursements.

Denial Analysis

At Mediculogy, we have a complete solution for denial analysis and their follow-ups.

Insurance Follow-Ups

We run aging reports to categorize (Oldest to Largest and highest to Lowest) Mediculogy

Patient Follow-Up

At Mediculogy, we follow up with the Patients to clear the outstanding payments.

Benefits

- An alternative to immediate collection agency placement.
- We successfully secure full benefits of claims previously denied.
- The provider can maintain good patient/provider relations with each other.

Medical Billers

- Submission of medical or operative records.
- Patient completion of coordination of benefits or other forms.
- Correction of improper billing information.Re-submission to the proper carrier.

Two-Pronged Strategy

- The first critical aspect is to proactively follow up on denied or rejected claims or requests out to relevant parties.
- Denial or rejection details are gathered, it's important to analyze and identify the specific reasons for denial.

Overview

We specialize in pre-collections follow-up for claims that carry a ‘reject/resubmit’ status and have aged beyond 60–90 days, making them ineligible for immediate assignment to collections.

At Mediculogy, we firmly believe in the substantial value of pursuing these types of claims on behalf of your healthcare facility. This becomes even more critical in light of resource limitations that can impede your facility’s ability to process these claims with the same timeliness as newer ones.

While many states have stringent rules for timely payments, a universal challenge for hospitals remains the difficulty in collecting accounts that have matured to the 60 to 90-day mark. Reprocessing such claims often poses a significant challenge. Our core mission is to alleviate the burden of un-collectible accounts on your facility’s financial health through our expertise in medical billing audit and denial management services.

Follow-Ups

At Mediculogy, we meticulously track denials, documenting every detail—what was denied, why it was denied, how it occurred, and when the claim was originally filed. Our process provides visibility across all stages of the claim lifecycle to ensure transparency and timely resolution.

We monitor and manage:

Pre-adjudication status – including accepted or rejected claims before processing.
Claims pended for development – due to incorrect or incomplete information during adjudication.
Suspended claims – where additional documentation or clarification is requested.
Finalized claims – for confirmation of resolution and closure.