Bridgestone Healthcare Revenue Management’s Web-based Denials Management Software (WEB-DMS) includes a robust and easy to use Work Flow module that includes automatic system Alerts.
With WEB-DMS Denied Charges are automatically routed to the appropriate work queue for resolution. Work queues can be based on any criteria necessary.
All Work Queues include ALERTS. Alerts set-ups are a feature in the system that typically is accessed by the supervisory staff.
What is an Alert?
An Alert is where the Denials Management System identifies any trend or action that is considered “unusual activity”.
An example could be your facility has during an average 30 day period about $100,000 in Denied Charges for ANSI Code 27, which is an Eligibility related denial code.
If in the current 30-day period the system identifies $130,000 in Denied Charges for ANSI Code 27 an Alert message will be sent to the Work Queue user, the user’s supervisor and the Bridgestone staff.
This will inform the staff that there is some unusual activity in the system. The intent is to inform the appropriate staff at the earliest date possible there may be a problem in the system.
Alerts can be created using any logic necessary. Here are some more real examples:
Chemo drug denied charges exceeding $30,000 in 15 days.
Claims within 45 days of Filing Limit.
Medicaid has 30% more Denied Charges than during an average 30 day period.
The number of Authorization Related Denied claims is 25% higher in the current 30 day period than the average 30 day period.
Alerts are created using any of the data elements in the system. With Alerts in place the staff and management will always be notified at the earliest possible moment when there is any unusual trend with Denied Charges.
For more information contact Wayne Gill at firstname.lastname@example.org or (619) 920-6147.