Denial Topic Encyclopedia

RevAssurance is committed to increasing your mastery and authority in claims payment compliance. The Denial Topic Encyclopedia is designed to help you navigate the regulatory landscape, understand denials and delay tactics, and understand the laws that secure your rights.

Each one of our encyclopedia pages addresses a different denial topic or some improper payment practice that payors often deploy. Each page starts by defining the topic in question. Then, we present a jurisdiction filter that refreshes the page with tailored resources depending on the type of health plan you are facing. These resources include:

• Rebuttal Script: Clicking on the “EXPAND” button opens a pop-up window that includes questions to ask yourself during the investigation of the claim. It also includes questions you may ask the payor during a phone call and lines of speech that you may use to respond to common defenses of the denial.
• Appeal: If the payor is unresponsive to your phone call, you are encouraged to appeal their determination by generating an appeal to send to their office. For your convenience, each topic page is linked with the appropriate appeal letter.
• Affidavit: If the payor is still committed to their determination, you can follow-up with an affidavit to commit them to their position in writing. Sending an affidavit is helpful when filing a regulatory complaint later.
• Law Citation (What does the law Say?): We also present specific laws—statutory, regulatory, or case laws—which govern the particular topic. The Law may outrightly bar the payment practice in question or it may dictate boundaries or protocol for payment compliance (e.g. authorization timeframes).
• Regulatory Agency: Ready to file a compliant? We also display the contact information for the proper regulatory agency which governs the selected jurisdiction.

For more information on how to use the Denial Topics Encyclopedia, members are encouraged to visit the Tutorial.