Denial Management

Recover more revenue and efficiently handle the appeals process.

According to MGMA (Medical Group Management Association), up to 65 percent of denials are never reworked because staff lacks the time and sometimes the knowledge to rework the claim.1 That means providers are leaving hard-earned, valuable money on the table.

Our denials management solutions enable you to understand the reasons for rejections and denials.

Our denials management solutions enable you to understand the reasons for rejections and denials. Through comprehensive reports and analytics, you can identify trends and take appropriate action to help prevent future issues. We also help automate the appeals process, identifying errors and creating appeal letters so you don’t have to perform these tasks manually.

1 Tina Graham. “You might be losing thousands of dollars per month in ‘unclean’ claims.” MGMA Connection magazine, February 2014.

See how TriZetto Provider Solutions can help you.

The support staff and reporting capabilities have helped our office run more efficiently. Thank you for the customer service and personal attention our office has received from TriZetto.
Jim — Radiology Billing, Orem, UT

Payer List

Our solutions are integrated with more than 3,400 payers so you can easily incorporate our solutions into your business. If you don’t see a payer on our list, contact us and we can likely add them.

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Our Packages

Our ultimate goal is to help you boost revenue. We achieve our goal by helping you work as efficiently as possible, eliminating paperwork and automating your most time-consuming and error-prone tasks.

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What’s New in Diagnosis Coding? Risk Adjustment for Physician Practices

Many practices are part of, or soon will be part of, Accountable Care Organizations (ACO) or other Alternative Payment Models (APM). These payment models will provide bonuses or penalties, based partially on the severity of the practice’s patient population. The payer uses diagnosis codes submitted on claims to determine this severity. Payments for individual physician services are based on CPT code, but now, accurately reporting co-morbidities and underlying medical conditions will affect reimbursement for physician practices.

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