Denials, Audits and Appeals
Affording you the opportunity for better processes, leading to the best results.
Today’s regulatory rich environment means that quality and medical necessity compliance is more important to revenue than ever. MorCare solutions help you manage and defend audits, claims and denied payments efficiently.
How it works: Our Denials, Audits and Appeals system integrates with our Care Management’s Utilization Review and Utilization Management feature to provide the following:
- Online audit tracking from insurers’ initial records requests to resolution
- Online denial tracking from insurers’ initial verbal denials to resolution
- Medical records tracking of documents requested and sent
- DRG validation, including initial and revised coding details
- Reporting that includes audit and denial types, and reasons and outcomes for revenue analysis
- Contact logs for recording and tracking interactions with payors and auditors
- Automated, organization-specific work lists
Denials, Audits and Appeals: Data Analytics Dashboard
Our Dashboards give your organization clarity and help provide data-driven decision support. You can use our dashboards for a visual, deep dive analysis paired with our robust reporting tools to interactively view items like volume metrics, insurance types and plans, initial vs recovery amounts, services KPIs, YTD discovery and more.