Q&A: Using denial analysis data

Q: What kind of information can a denial analysis provide and how can we put it to use?

A: Performing denial analysis on a regular basis will enable you to identify the top reasons for denials and develop action plans to improve processes. Development of a denials database or tool to track denials will allow you to identify trends that can lead to process improvements such as the following:

• Arrange claim adjustment reason codes into subcategories to identify the reason for denial, such as missing/invalid claim data, missing authorization, eligibility, medical necessity, etc. The subcategories allow for efficient research and review and help leaders to target improvement activities toward the functional area from which the denial is originating.

For more information, see the CHRI Exam Study Guide.