Patent ID: 8694343

Claim:
A web-based method for managing insurance claim denials for a plurality of healthcare providers, comprising the steps of: comparing a claim denial of a healthcare provider to a denial status grid comprising a list of denial types and an appeal success rate for each denial type on the list by a review module of a hardware server, wherein the review module provides a recommendation to proceed with or to decline to proceed with an appeal of the claim denial based on the comparison and a patient record associated with the claim denial; determining to proceed with the appeal of the claim denial based on the recommendation; preparing an appeals package comprising an appeals overturn letter and a supporting document in support of the appeal to the claim denial by the review module of the server; electronically submitting the appeals package to an insurer associated with the claim denial by an appeals coordinating module of the server over a communications network to file the appeal to the claim denial; monitoring the progress of the appeal filed with the insurer by a process management module of the server; processing an appeal determination electronically received from the insurer; and determining by an appeals decision matrix module of the server to file a second level appeal when the appeal is denied or partially denied.