DenailsNavigator™ - Feature Specification List

DenialsNavigator™ is a unified denials management solution that combines automated workflows, comprehensive reporting and root cause analysis to streamline your process and reduce denial rates. Key benefits of DenialsNavigator™ include:

• Support for all denials – institutional and professional for all payers
• Both claim and line level denial monitoring and reporting
• Workflows reduce staff time and lower days in A/R
• Root cause analysis facilitates training and education efforts and prevents future denials
• Easy to understand dashboards allow you to quickly monitor in-process activity

DenialsNavigator™ restructures the denials process. Instead of having PFS team members coordinate resolving all denials with other departments through phone calls and e-mails, DenialsNavigator™ routes each denial to the appropriate department(s) based on the workflow for that denial. The department determines the root cause, responsible department and outcome (e.g., rebill, write-off, appeal) and the system routes the denial based on the outcome. DenialsNavigator™ automates the denials workflow, which eliminates phone calls and e-mails and frees up staff to actually resolve denials.

At the heart of DenialsNavigator™ are triggers and workflows. Data driven triggers, based on payer, CAS reason code, remark code, diagnoses, procedures, etc., identify each denial and assign the appropriate workflow for the denial. That workflow then routes the denial to the department(s) that can best address that denial and determine the root cause. The system is configured with a set of standard denial triggers and workflows, which can be customized by the user.

DenialsNavigator™ is driven by 835 remittance files and supplemented with additional data from 837 claim files (e.g., physician). The system handles all denials (both claim level and line level) from all payers and supports multi-entity organizations (e.g., hospitals, clinics, physician practices). DenialsNavigator™ ensures that all denials are being addressed, measures the impact on the organization and reduces future denials through root cause analysis.

The ability to monitor and workflow denials within the DenialsNavigator™ system assures management that denials are being addressed and measures their impact on the organization. Root cause analysis of why denials occur and who is responsible promotes ongoing improvement and reduction of future denials. DenialsNavigator™ refocuses the denials process by using workflows to route each denial to the department or person that can best determine and correct the issue.

The customized targeting and tracking of the denials process allow you to workflow various denials to the departments within the organization that can most effectively address the denial. Users can specify their own denial triggers using a combination of CAS Reason codes, remark codes, HCPCS/CPTs, diagnosis and procedure codes, payers, etc. The DenialsNavigator™ product also has built in list of standard denial triggers that can be used or customized.

The comprehensive reporting of denials includes standardized reports by CAS Reason codes, remark codes, Revenue Codes, Attending/Operating Physician, Payer/Insurer, etc. Fully integrated with Wellington's AuditNavigator™.

To obtain additional information about Wellington’s DenialsNavigator™ offering, schedule a demonstration.