Denial Management Services

Effective denial management requires more than simply resubmitting a claim. Enlight provides structured support to review denied and rejected claims, identify the reason for the denial, determine the appropriate next action and follow up through resolution.

Our team works within client-defined workflows and payer requirements to help maintain consistency throughout the denial management process.

Denial Review

Our team supports:
  • Review of denied and rejected claims
  • Identification of denial reasons
  • Review of coding, billing, documentation, authorization, eligibility and payer-related issues
  • Evaluation of claim information to determine the appropriate next step
  • Categorization of denials for further analysis

Denial Resolution

Depending on the client's workflow and scope, our support may include:
  • Claim correction and resubmission
  • Review of accounts requiring additional information
  • Follow-up on outstanding denied claims
  • Documentation of actions taken and next steps
  • Escalation of accounts requiring client or payer intervention

Appeal Support

Enlight can support the appeal workflow by:
  • Reviewing applicable payer requirements
  • Identifying information needed for the appeal
  • Organizing relevant claim and supporting documentation
  • Tracking appeal-related accounts and follow-up requirements

Denial Trend Analysis

Recurring denials can indicate an issue within the revenue cycle. We can help identify patterns by:
  • Payer
  • Denial reason
  • Service type
  • Coding or billing issue
  • Documentation or authorization issue
  • Other client-defined categories
These findings can be communicated to the client to support process improvement and help address recurring issues.

Our Approach

Enlight focuses on consistent account review, appropriate follow-up and clear documentation. Denial management workflows can be aligned with the client's payer mix, business rules and existing revenue cycle processes.

Looking for the right RCM support for your organization?

Enlight can tailor its services to your operational requirements and provide support across individual revenue cycle functions or multiple RCM processes.

Connect with Enlight to discuss your requirements