Denials

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When an insurance company refuses to pay a claim for services rendered, MiraMed can help appeal denied claims and, ultimately, make sure you receive proper reimbursement for your submitted insurance claims. MiraMed systematically and vigorously pursues the appeal process to maximize reimbursements from contracted payers.

Failing to address increasing insurance denials from insurers directly affects revenue and cash flow. MiraMed has developed comprehensive strategies to mitigate the negative results of insurance denials. We are able to recognize, identify and correct the problems that cause claims to be denied by payers. Our denial management service has been refined over three decades.

Our tactics include:

  • Stratify, segment and work denials with our proprietary A/R tracker.
  • Classify denials by reason, source, cause and other distinguishing factors.
  • Develop and construct effective denial management strategies specifically designed to our client’s situation.
  • Implement strategies to successfully appeal and reverse unfounded denials. 

Most claims are adjudicated promptly and for the full contracted amount by payers. Even the best-performing hospitals and health systems typically experience denial rates of approximately three percent to five percent of all claims submitted. Providers often lack the staff or expertise to build and execute a focused strategy for denial management. MiraMed routinely processes the most complex claim denials and collects proper reimbursement, which ultimately results in optimizing revenue and improving cash flow.


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