Every denial becomes a case.
Every case has a next step.
In Expedite RCM a denied claim is not a line on a report. It is a case with a queue, a deadline and a recommended action, from the day the remittance is posted until the claim is paid, appealed, corrected or closed.
From the denial to the payment
Nobody keys a case in. When an insurance payment or remittance is posted, Expedite RCM finds the charges the payer denied and opens a case for each claim and payer.
- All the denied charges of one claim for one payer are grouped into one case
- Routine contractual adjustments are not treated as denials
- A new denial on a claim that already has a case is added to that case
- Every case is in exactly one work queue, so nothing is counted twice
The payer denies
The denial arrives on the remittance.
A case is created
Posting the remittance creates the case, grouped by claim and payer.
It reaches the right queue
Routed by payer or insurance class to the people who work those denials.
It is worked by deadline
Correct and rebill, appeal, or send records, with the days left in view.
It closes when it is paid
A paid case closes on its own. A claim denied again comes back to the list.
What you see when you open one
The days left
Estimated appeal-by and corrected-claim-by dates count down on the case, in red, amber or green.
A recommended action
Each denial code carries a category and what usually resolves it: correct and rebill, appeal, send records or review.
A priority
High, medium or low, from the balance, the deadline and how often that payer later paid that denial code.
A queue and an owner
The work queue it belongs to and the person who has taken it. An untaken case is open to every member of the queue.
A follow-up date
Set a follow-up and the case stays out of the working lists until that day, then comes back.
A status that follows the claim
Rebilling marks the case corrected and rebilled, an appeal records its level, and a closed case shows how it ended.
Lists that say what to do next
The same cases, grouped the way the work is done. Click a list to load it.
- My work and Untaken: what you have, and what nobody has taken
- Your queues, each with its number of cases to work now
- Deadline soon and High dollar: the most urgent cases
- Correct and rebill and Appeal: grouped by next step
- Rejected: claims rejected before adjudication that need attention now
- Follow up later and Closed: what is waiting, and what is done
- Workload: open cases by queue and person, for whoever assigns the work
More than the denial itself
Pre-bill rules
When a payer keeps denying a certain kind of charge, a rule can catch the next one while claims are being built. Each rule names the payers or insurance class, the conditions to look for, and whether the charge is held or billed with a warning.
Claim rejections
A claim the clearinghouse or the payer rejects before adjudication never produces a remittance. The rejection arrives in a claim acknowledgement, which is read when files are received. The claim becomes a case too, in the same queues and lists, and closes when the corrected claim is accepted.
Help with the case, and the whole picture
- Ask Jacqueline, the AI agent, for your queue, or for the cases with a deadline coming up
- Have it look up a case and draft the appeal letter as a Word document
- Tell it to add a note or set a follow-up; it asks for your yes first
- Denial Analysis shows which payers deny most, for which reasons, and what was paid afterwards
- Denial Activity shows who worked the cases and how they ended
- The Home dashboard shows open denials, what is due and what is untaken
See denial management at work
We will walk you through a case from the remittance to the appeal.
Request a Demo