RelayHealth Financial automates creation, management and tracking of denied claim appeals

June 27, 2016

RelayHealth Financial today introduced RelayAssurance Appeals Assist, a new tool that lets providers quickly and easily identify, create, file, and track appeals for denied claims. Now hospital and health system CFOs and revenue cycle leaders can enhance their denial prevention strategy with a way to expedite the appeals process– helping to reduce the associated time and costs, and improving the collection rate on initially denied claims.

While an estimated 6.4% of all provider-submitted claims are initially denied by payers, two thirds of those claims are recoverable. Yet many healthcare providers do not appeal denied claims at all, while others dedicate in-house staff or enlist outsourcing firms, which can result in lost revenue, wasted productivity due to manual processes, and significant expense. With RelayAssurance Appeals Assist, denied claims are flagged, the appropriate appeal forms are assembled and completed, and their progress is tracked–all within the same RelayAssurance Plus workflow used to monitor and manage claims.

Despite providers’ best efforts to submit clean claims, a substantial number still get denied,” said Marcy Tatsch, vice president and general manager, Reimbursement Solutions, for RelayHealth Financial. “An effective denial prevention strategy doesn’t just focus on pre-submission, but also on the other points along the claims continuum. RelayAssurance Plus already offers the robust editing, claim status, and lifecycle visibility capabilities that are essential to denial prevention, and now builds on that functionality with the ability to track a claim’s progress and quickly respond when help is required.”

RelayAssurance Appeals Assist complements the RelayAssurance Plus claims management suite by offering:

  • Integrated Denial ManagementUsers can quickly and efficiently identify that an appeal is needed, then create, print, and file that appeal and track its progress directly within the same RelayAssurance Plus workflow where claim status/tracking takes place.
  • Forms Library–Built-in standard Medicare appeal forms, templates and letters, along with state-by-state appeals submission requirements help reduce the time and effort required to file appeals.
  • Appeals Dashboard–Visual icons indicate the status of appeals (Created, Submitted, Denied, Succeeded), whether an appeal follow-up has been established based on payer-specific time thresholds, and alert users to filing deadlines–all to ensure active management of appeals.

RelayAssurance Appeals Assist is the latest module available to users of RelayAssurance Plus, RelayHealth Financial’s cloud-based, analytics-driven claims and remittance management solution. Other modules available to complement RelayAssurance Plus include: the new Status Amplifier, which automatically tracks down, inspects, and reports accurate reasons for non-payment on claims; RelayAssurance™ Medicare Direct Entry, for integrated Medicare claim processing, and automatically-generated secondary claims; Host Integration Services, which helps reduce the need to manually post transmitted claim status information; and Eligibility Claim Edits to monitor for insurance changes.