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Billers can spend anywhere from five minutes to several hours figuring out exactly why a claim is denied. This research can include:
- Looking up the claim in multiple systems
- Calling a payer and waiting for hours on hold
- Searching for policy documents to figure out exactly what happened with the claim
The best billers have an intuition for where exactly to look, given a specific claim, specialty, payer, state, or CARC/RARC code. Despite that, it’s still extremely tedious. We built Denials Intelligence to give that same intuition to every biller in every practice, hospital, or health system in the United States, So instead of spending all your time researching claims, you are spending time looking at a synthesized decision of what should be done to get paid.
How it works
Substrate's Denials intelligence takes all the information from all the sources available and reasons over them to figure out what exactly is wrong with the claim. Sources include:
- the Clearinghouse Claims status
- the Payer Portal
- the EOB or ERA
- your lockbox, including correspondences
- your clearinghouse
- clinical notes
- payer policies
- Medicare clinical documentation
- and more
All of these are combined and condensed into a discrete reason why the claim was denied and a specific change that you should make when rebuilding, appealing, or submitting a corrected claim. Here are a few examples.
Automatically retrieving check numbers when a claim is paid
Telling when you submitted a claim with the incorrect member ID, and what the corrected one is
Identifying when the claim was submitted to the wrong payer, and what the correct payer the claim should have been submitted to:
Identifying denials caused by timely filing or prior auth
There’s much more. Learn more about how it works here. And try it for your practice here.