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Automation of Insurance Denial Resubmission for Revenue Recovery
  1. case
  2. Automation of Insurance Denial Resubmission for Revenue Recovery

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Automation of Insurance Denial Resubmission for Revenue Recovery

enterbridge.com
Medical
Healthcare Services

Problem Statement

Manual processing of insurance denial resubmissions (CO250/CO252) consumes excessive labor hours (avg. 20 mins/denial), causes backlogs in complex denial resolution, and results in $2M+ annual revenue leakage. Cumbersome systems add 10+ minutes per transaction, with staff spending 1,000+ annual hours on repetitive tasks instead of strategic work.

About the Client

Regional healthcare provider focused on improving patient outcomes through optimized revenue cycle management

Project Objectives

  • Automate end-to-end processing of CO250/CO252 denials
  • Reduce manual labor by 1,000+ annual hours
  • Recover $2M+ in denied claims annually
  • Improve employee satisfaction by eliminating repetitive tasks
  • Enable staff to focus on complex denials and strategic initiatives

Functional Requirements

  • Daily automated login to Meditech and fax portal systems
  • Identification and prioritization of CO250/CO252 denials
  • Automated EMR chart navigation and document extraction based on service date criteria
  • Intelligent document selection for fax transmission
  • Automatic denial closure with audit trail documentation
  • Real-time processing status dashboard

Preferred Technologies

Robotic Process Automation (RPA) platforms (e.g., UiPath, Automation Anywhere)
Electronic Medical Record (EMR) integration frameworks
Secure fax transmission APIs

System Integrations

  • Meditech Denial Management module
  • EMR Chart Viewer
  • Communication Director fax portal

Non-Functional Requirements

  • Process 3,500+ annual denials with <2% error rate
  • Maintain HIPAA-compliant data handling
  • Support concurrent processing of 100+ denial cases
  • Ensure 99.9% system uptime during business hours
  • Provide audit-ready documentation trails

Expected Business Impact

Projected annual savings of 1,000+ labor hours through full automation, immediate recovery of $2M+ in denied claims, and 40% reduction in denial backlog. Staff reallocation to complex denials could unlock additional revenue while improving employee retention through reduced repetitive workloads. System scalability supports future automation of 15+ denial types.

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