The spreadsheet sort order problem
Open most denial trackers and the rows are sorted by date received. That's the order the work arrived, so it's the order the work gets done.
The trouble is that denials aren't equal. Some are large. Some are close to a filing deadline. Some are fixable in two minutes; others need a call to the payer.
A better default
A useful queue weighs a few things together:
- Value — how much money is actually at stake
- Status — what's already been tried, and what the next step is
- Fixability — whether similar denials have been resolved before
None of this needs to be clever. It needs to be consistent, so every biller starts the day looking at the same list in the same order.
Use the fixes you've already found
The fastest denial to fix is one your team has fixed before. If seven similar denials from the same payer were resolved by moving a modifier, the eighth biller shouldn't have to rediscover that.
In MEDBIX, denial intelligence looks at resolved outcomes in your own company and proposes a change. If there isn't enough history, it says so and stays general. Either way, the proposal only lands on a draft, and the claim goes back through scrubbing and approval before it's resent.
Measure the backlog, not just the count
"We have 312 open denials" says less than "we have $48,000 in denials over 60 days, mostly from two payers". The second sentence tells you where to put people tomorrow morning.
#denials#prioritization#a/r
