Managing insurance claim denials is a necessary yet often cumbersome process for many healthcare organizations. In order to overturn denied claims, providers can process thousands of insurance claims a day and must accurately match each patient and case. From there, they must consult with a physician advisor on each denied claim to overturn them. This multilayer process often relies on manual workflows that can result in inaccurate data, missed claims, and wasted hours. So, when one of the largest healthcare providers in the U.S. sought to improve their denial notification process and gain operational efficiency, they realized that a custom web application could be their answer. They partnered with UDig to build the solution and modernize the way they work.

Our client was managing thousands of denied insurance claims a day. These claims were coming from many different insurance companies in various formats, such as faxed sheets and handwritten notes. Their goal was to overturn as many claims as possible in order to recoup lost revenue. However, their existing process wasn’t enabling them to work efficiently to overturn those denials. They used a manual process for storing and sharing data that required many hours of employees’ time. 

The organization’s existing process: 

• Was not scalable, limiting the number of denials they were capable of overturning 
• Enabled human error when manually managing data, complicating their ability to work efficiently

This cumbersome process resulted in the company falling behind in their ability to process the volume of denied claims they received each day. As a result, they were leaving millions of dollars on the table.