Commercial payer denials management

Streamline the denials and appeals process.

Handling denials and appeals can be time consuming and costly. Optum™ Executive Health Resources® (EHR) physician advisors help simplify the process.

Denials, downgrades and pends issued by commercial payers continue to present reimbursement challenges for today's hospitals. Handling denials and appeals is time consuming and can be costly. Our commercial payer denials management solution streamlines these processes and allows your hospital to track results and predict trends.

EHR physician advisors work with hospitals to overturn commercial payer clinical denials before a patient leaves the hospital. Appealing inappropriate commercial denials at the point of service can reduce the impact of denials on a hospital's bottom line. Our physician advisors will also manage the retrospective commercial payer appeal process including the composition of expert, clinical appeal letters. EHR leverages its proprietary workflow technology system to ensure that each case is coded, tracked and appealed through every payer, state and regulatory level available.

The result of EHR's extensive knowledge of payers on a national level and consistent process is an unprecedented ability to overturn inappropriate commercial payer denials consistently.

Changing health care rules and regulations focused on medical necessity are a continual source of confusion for hospitals and other health care providers. To stay on top of the latest news and strategies regarding medical necessity compliance and appeals management, EHR has created The Compliance Library.