Closed Loop Denial Prevention Process

To Prevent Denied Claims “When Rules are Used” is as Important as “What Rules are Used”

AccelaSMART, the powerful processing and editing engine in the White Plume suite of products, is uniquely effective in ensuring that claims are paid not only because of what it does but also because of when it does it. Many editing tools apply editing technology to assembled encounters after they are already posted in the PM system.  One supervisor, an AccelaSMART user for over 10 years, says “I have an issue with using this type of tool [PM system editing tool].  Its [logic is applied] AFTER the charge has been placed in your system. That means, if any correction has to be done, it’s a messy process, reversing charges, recreating claims, trying to…communicate with a Coder/Office on how to fix the charge.”

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Creating a Closed Loop Denial Prevention Process

What is a closed loop denial prevention process?

  • Closed loop; noun - a control system with a feedback loop that is active
  • Denial; noun - the refusal to satisfy a claim, request, desire, etc.
  • Prevention; noun - an action that stops something from happening
  • Process;noun - a systematic series of actions directed to some end

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