Health insurance denials could be causing your organization to lose a significant amount of revenue each year. We can help your organization optimize profitability with our denial management process, which has lead our clients to see a dramatic reduction in health insurance denials and a measurably improved bottom line

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We will provide a comprehensive evaluation of processes, source of denials and reason

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Analysis of pre-service, concurrent and post-service review protocols

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If effective tracking methods have not been implemented for your organization we will help you to develop and implement these.

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We will thoroughly review denied charts to determine causation

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We will review local and national regulations to help determine how they are effecting your organization and denial rates

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We will provide a detailed strategy to target the denial and appeal process focusing on implementing improvement within your organization

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BHM will make handling denied claims manageable by inserting management protocols, introducing improved technology and implementing tracking and benchmarking procedures

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We will create methodology for your organization to easily manage the appeals process

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Implementation of targeted training for the utilization review and case management staff as well as clinical staff that will be targeted to addressing specific issues within your organization

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We will work with you to improve relationships and terms with payers to ensure that your organization maintains a low denial rate into the future.

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Development of overall tracking methods to help you determine the cause of denials

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Review of managed care contracts that have a bearing on claims payment

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Prevention of physician reviews and thus denials

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Training programs to address specific denial issues

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Assessment of billing practices that may delay the claims process

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Providing a methodology to focus on denials and appeals

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Providing training for the utilization review and case management staff

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Reasons for denial insurance claim

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Denial appeal status

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Provider and payer responses to authorizations

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Provider and payer responses to concurrent insurance claim denials

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Information regarding physicians and departments involved in the insurance denial process

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Case-management notes

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Level of care determination

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Revenue which is lost or at risk

Testimonials

A lot of consulting firms claim to have experience with denials, but few have meaningful expertise in the very different world of behavioral health revenue cycle. I was very impressed by the results that BHM obtained for our organization. We saw a measurable 80% reduction in denials after implementing the recommendations. I would highly recommend the experts at BHM for anyone looking to make a significant impact on their behavioral health operations and to improve their bottom line.

Steven P. Johnson

President/COO - Hospital Operations
SSM Health Care St. Louis, Mo