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Questioner
Mayur, When a claim is denied, what strategic step should AR teams take before calling the payer to ensure the call results in an immediate resolution, not just another hold?
Mayur
Before calling the payer, the AR team must conduct a digital audit trail check. They must verify within their own RCM system that the corrected claim or appeal documentation was successfully received by the payer before the call.
The most common call inefficiency is arguing whether the payer received the paperwork. By having the electronic transmission receipt, confirmation number, or fax log ready, the agent can bypass the initial dispute and immediately move to the status of the received appeal, forcing the payer representative to address the core denial issue.
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