Reducing Denials and Improving First-Pass Claims Acceptance
U.S.-based DME supplier specializing in respiratory equipment, CPAP supplies, oxygen equipment and recurring supply orders.
The challenge
The supplier was seeing frequent claim denials Most of them traced back to the front end: eligibility that was never checked, missing documentation, authorizations that were not in place and claims sent with errors. Each denial had to be reworked by hand, which slowed payment and kept the billing team busy fixing old claims instead of sending new ones.
Our approach
- Verified insurance eligibility and benefits before claim submission.
- Reviewed authorization requirements and supporting documentation.
- Put claim-scrubbing checks in place to catch common errors.
- Set up a denial work queue with payer-specific follow-up procedures.
- Tracked first-pass acceptance and denial trends through regular reporting.
Results
| Metric | Before | After |
|---|---|---|
| Initial claim denial rate | 15% | 8% |
| First-pass acceptance rate | 85% | 92% |
| Claims worked within 48 hours of denial | 60% | 95% |
| Average days in A/R | 58 days | 43 days |
Business impact
Checking eligibility, authorizations and documentation before submission brought the initial denial rate down from 15% to 8%. Denials that did come back were worked within 48 hours 95% of the time, up from 60%, and average days in A/R fell from 58 to 43.
How Salyx RCM supports DME providers
Most avoidable denials start before the claim is sent. These are the services we use to catch those problems at intake and to follow up on anything that still gets denied.
- Eligibility and benefits verification
- Prior authorization and documentation tracking
- Claims submission and denial management
- Insurance A/R follow-up and appeals
- Payment posting and reconciliation
- Recurring rental and supply billing support
- Payer-specific reporting and performance monitoring
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