BETTER DENIAL MANAGEMENT
OUR TRACK RECORD IN DENIAL MANAGEMENT IS UNMATCHED
As important as responding timely to claim denials can be, hospitals can sometimes have trouble keeping up with the number of insurance denials they receive. Titan Health can provide the staffing resources needed to expand the capacity of your hospital’s collection team.
When full or partially-denied claims are assigned to Titan for resolution, we evaluate the underlying cause, then correct and resubmit the claim or submit an appeal or reconsideration request. We monitor the claim throughout the collection process, balance the account, and document each step along the way. We also report on the root causes and recommend process or system changes necessary to prevent future denials.
Evaluation
The first step in the process is to evaluate the claim and determine the reason for its denial. This step is foundational to the rest of the process since the next steps depend largely on the reason the insurance provider denied the claim.
Titan Health can perform these evaluative processes for you, easing the administrative burden on your staff. Given the sheer volume of insurance claim denials, this step alone can significantly improve the efficiency of your back-office personnel.
Resubmission/Appeal
Once our team identifies the clear reason for the denial, we can begin the process of resubmission or appeal.
In some cases, this process only requires that our team perform the necessary corrections to resubmit the claim to the insurance provider. But when an appeal becomes necessary, our team can also deliver specialized insight to ensure that claims
get handled properly.
Monitoring
Titan Health will monitor the claim throughout the entire process. This minimizes friction in the resubmission or appeals process, preventing claims from being ignored or declined by the provider.
By monitoring the process carefully, our team can respond quickly to requests for additional information or offer clarification at the request of the insurance provider.
This attention to detail will likely shorten the processing time for claim resubmissions and ensure that you adhere to all of the deadlines.
Balancing the Account
Both you and your patients need a clear understanding of how much the insurance company will cover and how much remains each patient’s responsibility. The right denial management solution will help you balance the account, clearly identifying the amount that has been paid and the amount that still remains.
This step can also ease the administrative burden on your back-office personnel. This way, you won’t have to worry about re-examining account balances once a claim has been resubmitted and approved by the insurance provider.
Documenting Each Step
Even in a digital economy, healthcare institutions rely on a paper trail to verify that they have performed due diligence on each step of the claims process. By documenting each step of the resubmission and/or appeals process, you’ll gain greater end-to-end visibility and be able to keep your records updated accordingly.
Documentation can become crucial if you ever face a payment dispute between you and an insurance provider. And with a clear record of your attempts to submit and resubmit a claim, you’ll also be better equipped to write off bad debt should all other attempts fail.
Identifying the Root Cause
Perhaps most importantly, Titan Health can help you pinpoint the reason that the insurance company originally denied the claim. By determining the reason, you and your staff will be better equipped to make appropriate adjustments to prevent problems from recurring.
To that end, Titan Health can also provide recommendations on how to alter your processes or systems to prevent future denials. This input can prove invaluable as your medical facility continues to adapt to the ever-evolving regulations and procedures associated with insurance claims.
Minimize Lost Revenue
If you’ve been struggling with a large volume of denied claims, you could be missing out on a substantial amount of revenue. Many times, your back-office staff will prioritiz larger claims, but this only creates a backlog of smaller ones, all of which can snowball into a major draw on your resources.
Claim denial management will streamline the entire process, identifying claims to resubmit and claims to appeal. This benefit alone is often worth the investment, as hospitals and other healthcare centers can enjoy increased revenue now that more claims are being approved.
Optimize Your Process
Ideally, a claims management provider can help you understand the reasons behind your denials. It’s not uncommon to have recurring denied insurance claims — and they’re often denied for the same reason.
By leveraging the experience of a claim denial processing partner, you’ll be able to highlight problem areas in your billing process. Once you identify the source of your insurance denials, you’ll be able to adjust your process to prevent these problems from happening in the future.
Over time, this results in greater efficiency across your entire billing process.
Increase Your Operational Efficiency
Your back-office staff can quickly find themselves overrun by a backlog of denied claims. Sifting through these denials to resubmit or appeal claims steals time away from the revenue-generating activities that make your medical practice thrive.
By outsourcing these core tasks to a specialized provider like Titan Health, you allow your administrative staff to reallocate their time to other priorities. For instance, your staff can focus on filing more claims, which enables you to handle greater patient volume without compromising.
Standardize Your Existing Systems
A new claim denial management system will allow you to standardize your process of working through claim denials. Rather than devoting excessive hours to following up on denied claims, you’ll be able to efficiently address denials by outsourcing them to a third-party provider.
Not only does this improve your administrative efficiency, but it also makes it easier to train new staff thanks to a set of standardized processes. And because you’ll be spending less time focusing on managing denials, you’ll have more opportunities to develop standardized processes for other core tasks.
Document the Claim Denial Process
One of the most important parts of revenue cycle management relates to documentation.
The right claim denial management solution can provide you with documentation about the entire process, which can be particularly helpful in understanding your relationship with insurance providers and learning more about why your claims are being denied.
By documenting the process, you’ll also have the data you need to make adjustments to your existing system to prevent future denials. And if you’re still unable to reclaim this medical debt from the insurance company, you’ll have the documentation required to write off bad debt.
ADDITIONAL DETAIL ABOUT DENIAL MANAGEMENT
Every year, insurance providers deny millions of healthcare claims. For medical providers, claim denials represent lost revenue as well as an unnecessary administrative challenge.
The Healthcare Business Management Association reports that nearly a third (30%) of all healthcare claims are denied or ignored upon their first submission. Given that many of these claim denials are for advanced procedures, your practice could risk a
significant portion of your revenue.
Thankfully, Titan Health offers claim denial management solutions that emphasize recovery and prevention, helping you claim the funds that you’re entitled to while preventing future denials.
For example, errors in billing codes can easily lead to having a claim denied by an insurance provider and force you to either take corrective measures or write off the claim entirely.
Additionally, not all denials are the same. Denials can be classified as follows:
Soft Denial : Requires corrective action and resubmission
Hard Denial : Requires an appeal
Preventable Denial : Typically the result of inaccuracies Clinical Denial : Typically because of a lack of medical necessity Denial management requires you to address the soft and hard denials through resubmission and appeal, while preventable denials are best addressed by optimizing your system to minimize errors.
Lost Revenue
The most immediate consequence of a claim denial is the loss of initial revenue. A denied claim means that you won’t receive payment for your services and must write off the cost. If insurance providers deny coverage for advanced or experimental medical procedures, you could face a substantial loss in your overall revenue.
Even if your staff can address the reason for the denial, it may still take longer to receive a payout. As a result, you’ll see a constriction in your cash flow, which can jeopardize your ability to meet internal costs like supplies, wages, and administrative expenses.
Increased Administrative Burden
When an insurance claim is denied, your staff is forced to re-examine the claim, determine the reason for the denial, and then take steps to resubmit the claim or appeal the denial.
If nearly one in three insurance claims is initially denied, it’s easy to understand how your administrative personnel would be burdened by a high volume of denials. And the time spent on your current denial management process prevents you from filing new claims. It can also cut down on your patient volume.
Compromised Patient Care
At a minimum, a denied claim means that your patients will have to wait to receive the care they need. In other cases, patients could be denied care altogether. Sometimes, the denial might be based on a lack of clear medical necessity, while other times, something as simple as a spelling error could jeopardize a patient’s treatment options.
At Titan Health, we don’t believe that medical care should ever be dictated by bureaucratic processes, nor should patient health be compromised based on administrative errors. By finding the right claim denial management system, you’ll be able to maintain a high standard of care for each of your patients.

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SEE WHAT BETTER RCM CAN LOOK LIKE FOR YOUR ORGANIZATION
WE DELIVER RESULTS THAT MATTER
Secondary Review, Primary Results
$3 MILLION
Identified in missed
revenue as a secondary
vendor for a large
Southwest Hospital,
reviewing 920 accounts
in just 7 months.
Partnership That Delivers
$36 MILLION
Recovered over 10 years
for a Southwest health
system, including $8M in
2023 alone.
Focused Commercial Claims
$17 MILLION
Recovered from
commercial claims
only, averaging $1-2M
annually for a large
Midwest medical center.
Specialized Solutions
$750,000
Recovered in one year
for a Midwest hospital,
focusing solely on
coordination of benefits
claims.
Titan Health has a solid track record of helping healthcare systems manage their revenue. While working with a client from the Southwest, we discovered that select outpatient services were being significantly underpaid. The reason had to do with the payor’s reimbursement, which excluded the cost of some of the medications used during these outpatient treatments. Once Titan Health got involved, we discovered that the problem was primarily due to a clerical error that caused the payor to treat these procedures as outpatient surgeries. The payor was processing the claims based on case-rate reimbursement, which ultimately meant that they did not cover the cost of certain prescription drugs. Titan Health was able to resubmit these claims with the appropriate information, which prompted the payor to immediately pay for the prescribed drugs. In the end, the health system successfully recovered $500,000 in underpaid health claims, and the corrections they made prevented further loss.
Case Study: $500,000 Recovered