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Claim Appeal and Denial Support Add-on


Claim Appeal and Denial Support Add-on
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Publisher: Optum360
Experts: Ryan Devey
Sample Pages:  View PDF

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QtyEdition & FormatAvailabilityPrice
Online
April 2017 $499.95


 

The 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. Additionally, for each code, this tool provides information from Optum360 Evaluation and Management Coding Advisor AND The Auditor’s Desk Reference books, as well as access to the new Optum Lynx E/M Coding tool. All of these features and content arm the coder with information to avoid denials and evidence for effective appeals.

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Features and benefits


  • New — Optum360 Edge — Sourcing information brings credibility to each claim edit in the Physician Compliance Editor feature (EncoderPro.com Expert and Payer). Each “scrubbed” claim now has industry standard coding guidelines that explain the coding errors identified on the claim. This claim edit information is essential when providing evidence for claim appeals for nonpayment. 
  • Optum360 Edge — Access to Optum360 Evaluation and Management code book data that is tied to each E/M code. This gives clarity to E/M coding which has been traditionally the most difficult and most often coded section of codes. Code E/M services at the right level and ensure that you have the most correct guidelines to support your E/M code selections. 
  • Optum360 Edge — Access to Optum360 E/M code evaluation tool. Users can select checkboxes to identify their history, exam, and medical decision making levels, and the Optum360 E/M code evaluation tool will supply the correct code based on 1995 E/M coding guidelines and logic.
  • Optum360 Edge — Access to Optum360 Auditor’s Desk Reference code book content. Know, by code, what coding auditors evaluation when checking for correct coding. Understand those “hard to code” pitfalls and learn the correct coding to overcome common denials and coding mistakes.



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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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