Healthcare providers don’t lose money because they don’t deliver care—they lose money in the gaps between documentation, coding, eligibility, authorizations, and claims. In a high-volume environment, small process errors compound into denied claims, delayed reimbursements, and avoidable write-offs. Revenue Cycle Management (RCM) teams often work under constant pressure, juggling payer rules, clinical documentation variability, and frequent rework.
A multi-specialty healthcare provider was experiencing increasing friction across its revenue cycle. While patient volumes were growing, cash collections were not keeping pace due to claim delays and denial rates that were trending upward.
The client faced several issues:
High denial volume and rework
Denials were frequently caused by eligibility mismatches, missing authorizations, incorrect coding combinations, and incomplete clinical documentation. Denial handling was reactive, and teams were spending too much time on appeals rather than prevention.Fragmented workflows and limited standardization
Eligibility checks, prior authorization tracking, charge capture, and claim submission were handled across multiple tools and manual trackers. Processes varied by department and facility, making performance inconsistent.Slow turnaround for claim submission
Claims were often submitted late due to manual coding queues, missing documents, and lack of proactive issue identification—extending days in A/R and delaying cash.Payer rule complexity
Different payers had different requirements for medical necessity, coding edits, and documentation standards. Staying current and consistent was difficult, leading to avoidable errors.Limited operational visibility
Leadership lacked real-time visibility into denial root causes, aging trends, and bottleneck stages (front-end vs mid-cycle vs back-end), making it hard to take targeted action.
The business objective was to move from denial management to denial prevention, shorten time-to-cash, and improve collections predictability.
Maayan Technologies implemented a structured revenue cycle support program spanning front-end, mid-cycle, and back-end operations, with a focus on process discipline, automation, and analytics-driven decisioning.
1) Front-End Strengthening: Eligibility & Authorization Controls
We introduced standardized checkpoints to prevent downstream denials:
Eligibility verification rules and exception handling workflow
Pre-registration validation to reduce demographic and payer data errors
Authorization tracking discipline with clear ownership and escalation
Patient responsibility estimation support (where applicable)
This reduced claim rejections caused by incorrect payer details or missing approvals.
2) Documentation & Coding Accuracy Improvement
We supported coding quality by establishing:
Documentation completeness checks to ensure clinical notes supported billed services
Coding review practices for high-risk categories and common denial codes
Standard coding/edit guidelines aligned to payer requirements
Feedback loop between denials, coders, and clinical teams
Where document volumes were heavy, Intelligent Document Processing (IDP) helped ensure required attachments were present and correctly associated before claim submission.
3) Claims Readiness & Clean Claim Submission
We implemented “clean claim” readiness steps to reduce errors at first submission:
Pre-bill checks and missing-data flags
Basic edit validation aligned to payer rules
Correct attachment mapping for claims requiring documentation
Standardized claim batching schedules and queue management
This reduced claim rejections and minimized payment delays caused by avoidable first-pass issues.
4) Denial Management with Root-Cause Analytics
For existing denials, we built a structured denial workbench approach:
Categorization by denial reason, payer, department, and procedure type
Prioritized work queues based on dollar value and appeal deadlines
Standard templates for appeals and medical necessity responses (where applicable)
Root-cause reporting to prevent repeat denials
Rather than treating denials as one-off events, the program focused on repeatability and prevention.
5) A/R Follow-Up and Collections Acceleration
We improved back-end collections by:
Payer follow-up cadence and aging-based prioritization
Clear ownership for high-dollar claims and stuck accounts
Underpayment detection triggers and secondary claim workflows
Controlled write-off governance and reporting
6) Compliance & Security Discipline
Given PHI sensitivity, workflows were aligned with access control, audit trail needs, and secure handling practices. Documentation standards and operational logs improved compliance readiness.
The provider saw improvements across denial reduction, cash acceleration, and operational control:
Fewer denials due to stronger eligibility/authorization validation, improved coding discipline, and clean-claim readiness.
Faster payments through reduced claim rejections, quicker submission cycles, and tighter A/R follow-up.
Lower rework load as prevention reduced repeated denials and appeal volume.
Better visibility into payer performance, denial root causes, and aging trends—supporting targeted corrective actions.
More predictable revenue operations with standardized workflows across departments and facilities.
Improved compliance readiness with better documentation discipline and traceability.
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