Successful denial management is a key piece of both the patient experience and a thriving revenue cycle — with denials increasing in both frequency and volume, the need for effective solutions to assist hospitals in obtaining appropriate reimbursement is critical. Nemadji has developed Resolve, a fully customizable solution to support and optimize your hospital’s existing efforts to ensure you receive the reimbursement you are entitled to.
Hospital staff are stretched thin and deal with many competing priorities—let our well educated and easy to work with team relieve the denial burden on your staff. Our exclusive platform prioritizes denials based on the needs of each facility we work with, to ensure they receive the rightful reimbursement for services provided—with minimum implementation and maintenance.
A patient visited the Emergency Department for a psychiatric disorder. Due to the patient’s medical state at the time, no insurance information was provided.
Insurance information was obtained at a later date and the hospital billed the patient’s insurance. The claim was denied due to no pre-certification/authorization and the hospital adjusted off the charges.
How Did Nemadji Help?
Nemadji reviewed the account and prepared an authorization appeal that included the patient’s medical records to be submitted on behalf of the hospital.
The denial was overturned and the hospital received payment for the services they provided, payment that was previously adjusted off.