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Home > Claim Appeal and Denial Support Add-on

Claim Appeal and Denial Support Add-on

Claim Appeal and Denial Support Add-on
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Publisher: Optum360
Experts: Ryan Devey

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QtyEdition & FormatAvailabilityPrice
April 2017 $499.95


This Claim Appeal and Denial Support add-on provides, for any claim edit, the actual sourcing for that edit. For coders, this means no more searching for code guidelines for claims appeal support. Simply click a link to see the coding guideline, directly from the source, as to “why” the edit may be an issue on your claim. For payers, you now have access to coding guidelines for possible claim adjudication review.

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Features and benefits

  • Sourcing for ClaimsManager Edits. Customers can see from where the edit originated, and even have hyperlinks to the sourcing for the edits.  This is especially valuable when looking at state level Medicaid editing.   This can be used when submitting an appeal to justify coding and instruct payers of specific guidelines.
  • Access to the Auditor’s Desk Reference content. On each detail page, we have information from Optum360’s Auditor’s Desk Reference (AUDR) that provides guidelines of what auditors look for when doing audits for these codes.  Knowing this allows you to bill it correctly the first time…thus avoiding denials.
  • Access to the Evaluation and Management Coding Advisor (EMCA).  Same as AUDR, where a code is referenced, you can see E/M guidelines specific to the E/M code you are billing for proper E/M code selection.  
  • Both the AUDR and EMCA are also searchable by code and keyword. 


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Content Experts

Ryan  Devey - Product Manager, EncoderPro.com
Employed at Optum360 for 10 years

Ryan graduated from the University of Utah in healthcare administration and has worked for multiple commercial payer organizations in several different roles. Additionally, Ryan worked as a practice administrator for a physician clinic, where he implemented an EMR system and a fully electronic coding and code review process. For the past 10 years, Ryan has designed and managed medical coding data management systems, workers compensation rebilling systems and medical coding/fee schedule software.

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