DenialPro+ Premium Healthcare Claims Denial Management

DenialPro+ captures HIPAA 835 or flat-file remittance data, links it with data from your hospital or physician billing system, and transforms it into a powerful claim payment and denial database.

Powerful Analysis for Immediate Impact

Immediately target high dollar, high volume medical claim denial reasons: abundant statistical analysis reports and charts direct your attention to problem areas. Monitor monthly trends by check or service date… Review denial, recouped denial, and net figures from every angle… Measure denials as a percentage of total charges/number of accounts… Prepare and distribute denial information by service location to hold outlying departments accountable.

DenialPro+ meets all your long-term analysis needs by allowing countless combinations of statistical grouping options, including:
  • Payer/remit type
  • Denial reason code/category
  • Patient type/status
  • Facility
  • Service location/department/physician
  • Denial reason type: clinical/technical
  • Check/service date
  • … and many more!

Accelerate Denial Corrections and Appeals

DenialPro+ immediately categorizes and distributes denial workload, providing complete claim adjudication detail to assist with denial resolution. In addition to pertinent patient account information, data presented with each denied claim includes:
  • Primary claim denial reason
  • Up to 4 secondary denial reasons
  • Billed/paid/denied/contractual amounts
  • Coinsurance/deductible amounts
  • Policy number/claim control number
  • Complete denied line detail
  • Cross-over/corrected payer information
  • Many DenialPro+ calculated fields (such as net paid, denied, and reversed dollars when multiple claim payments are returned for the same account)
  • … and more
Optional work-list features include capabilities to:
  • Refer to a recommended denial action
  • Resolve denials with facility-defined actions
  • Identify and flag denials by HCPCS or other criteria
  • Attach notes to a denied claim

Hit the Ground Running

Since DenialPro+ is pre-packaged with payer-specific processing tables, 835 code sets, and default user-defined dictionary values, it is ready to use the same day it is installed. Begin using the software immediately, then take your time fine-tuning non-critical dictionaries based on the specific needs of your facility.

Implement at your own pace: start with just one or two users to get a jump on building your denials database (and start using the powerful statistical report options). Or, jump right in to reap all the benefits, now. Regardless of your implementation timeline, ISI will be with you every step of the way, with continued training, suggestions, solutions, and technical support.

Additional Features

  • Imports HIPAA 835 remits and HIS data-feeds
  • Any report: directly e-mail, or download to Microsoft Excel
  • Data-tool spreadsheet views
  • SQL Server database option
  • Includes all standard 835 RemitPro features
  • Fully integrated with EOBPro

Free Test Drive

Forward us up to one month of HIPAA 835 remittance files, and we will deliver powerful statistical reports compiled from your own data.

Contact us now to schedule a product demonstration, arrange a free test drive, or to obtain more information on any DenialPro+ feature.