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Denials Management

Denials Management

This category is a work in progress
Ability to produce clean claims to minimize denials and to efficiently process and resubmit denied claims.

Denials Management: Products


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Filter products


EMR compatibility

Star rating

Product attributes
  • Covid-19
  • Pediatric
  • In Epic App Orchard
  • In Cerner App Gallery

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EMR used

Organization size

Type
  • AMC
  • Pediatric Facilities
  • ACO
  • Rural Presence
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FUSE eliminates the manual reconciliation of remittances to deposits, along with the manual posting of payments into the patient accounting or practice management system.
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AdmissionCare helps the admitting physician make initial bed status determination and document appropriately to increase payer reimbursements and reduce denials. The problem is, patients placed in the wrong bed status with improper documentation results in massive revenue loss and patient dissatisfaction, and that is frustrating. We believe it’s just wrong that physicians are being pulled away from patient care in order for the hospital to get paid.

Here’s how we do it:

1. Integrate AdmissionCare into your EHR

2. Determine the right bed status

3. Document appropriately

4. Collect payment for services provided

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EMRs supportedEpic, Cerner, Allscripts +1 more
SolutionsDenials Management Tools, Clinical Decision Support Systems, ED Triage
Keywords cdsm, denials management, ehr integrated +1 more
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Payers constantly change the rules. Sift evens the playing field. Sift equips healthcare organizations to fully leverage their payments data to work smarter, protect their margins and accelerate cash.

Actionable Denials Intelligence, delivering a longitudinal view of clinical, coding, claims and remittance data. Sift establishes a data foundation that gives providers unprecedented access to their payments data and intelligence tools to better manage their denials, identify root causes and prevent future denials. 

  • Unified, normalized and organized claims and remittance data.
  • Delivering an accessible and complete picture of claim behavior, payer trends and the drivers of denials.
  • Curated, consultative analysis pinpointing where your team can take action to prevent denials and optimize workflows.

Denials Prioritization & Intelligent Automation to better manage touches and lower the cost of delivering each dollar of cash.

  • Sift’s machine learning optimizes workflows by prioritizing your team’s denial work efforts around ROI and by delivering Smart Claim Edits that improve first-pass yield. 
  • Active-Learning Claim Scrubber analyzes daily claims and remittances to curate high-impact claim edit recommendations.
  • Machine learning models that score denials at an atomic claim level, using over 500 attributes to determine each denial’s likelihood to overturn.
  • ROI-based denials worklists seamlessly integrate into your EMR, prioritizing high-recovery denials in staff workqueues.
  • Scoring that enhances existing automation capabilities, enabling the strategic automation of low-yield accounts while avoiding over-automating recoverable accounts.

Denials Prevention. By unifying clinical, coding and payments data, Sift's ML predicts denials before claims are created and provide recommendations for upstream interventions. 

Sift’s ML models predict the likelihood of denial and provide pointers for intervention and prioritized user analysis, working to optimize payment outcomes.

  • Machine learning models score encounters around their likelihood of being denied, proactively flagging encounters for intervention before claim submission.
  • Denial category prediction and root causes pointers enable routing to the appropriate mid-cycle workflow for mitigation.
  • Mid-Cycle Denials Intelligence that ties back-end billing, denial and overturn patterns to upstream workflow data inputs to deliver root cause analysis and prevention recommendations.

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Assurance Reimbursement Management is an analytics-driven claims and remittance management tool that helps healthcare financial managers efficiently manage all types of payer claims, including commercial, Medicare, Medicaid, and Worker’s Compensation, in one integrated system. Assurance provides ongoing claim visibility and supports proactive just-in-time follow-up until payment is received. Assurance Reimbursement Management gives hospitals, physician practices and other ancillary providers the capabilities to accelerate claim payment, limit denials, improve resource utilization, and reduce costs.
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Acuity Revenue Cycle Analytics is an analytics platform that leverages data from across the revenue cycle continuum (from patient access to remittance) to provide a holistic, cross-functional view into behaviors, processes and trends for the purpose of making timely decisions impacting financial outcomes, staff productivity and patient experience. • Dashboard showing a snapshot of critical information to quickly and easily identify problem areas in the revenue cycle. • Data compilation is automatic and in near real-time. • 80+ standard (yet also customizable) reports are available. • Users can create unique reports using any available criteria for unique use cases. • Suggested performance thresholds based on industry-wide data give context for whether performance is exceeding, on track or lagging goals. • Offers suggested thresholds or customize to meet unique needs. Visual indicators highlight when performance is outside of thresholds. • Acuity Advisor helps guide use of the wealth of data within the application by suggesting reports for common issues. • Reporting Bundles include visibility into data to improve processes in Patient Access, Services Rendered, Billing Efficiencies, Reimbursements, Denial Analysis, and Payer Relations.
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EMRs supported

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SolutionsDenials Management Tools, RCM Business Intelligence & Reporting Tools, Revenue Cycle Management Services
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