If you want significantly reduce medical glosses from your health plan operator, carefully read this article with infallible tips and success stories with up to 95% reduction! The term glosses is well known to health plan operators and everyone who works with hospital management, especially in the financial and billing area.

Here on our blog, we already talk about them! We have content on what the glosses, which are the non-payment of a service performed by a healthcare provider, about the types of existing glosses, administrative, techniques It is linear, and also about the impacts that glosses have on health institutions.

To make you even more informed on the subject, let's talk about the gloss feature: what this process is, how it works and what are the benefits of using an audit system for your operator that has the disallowance feature.

Continue reading until the end! ; )

Importance of good gloss management in operators

Before we talk about the disallowance feature, it is necessary to understand why managing disallowances is essential for a health plan operator.

When you have a good management of all information that circulates between operators and medical teams and there is a good organization of the work carried out, both in the work environment and in meeting deadlines, glosses tend to be avoided.

Furthermore, have internal processes that allow information in the operator's records to be constantly updated and secure it also causes glosses to occur in fewer quantities.

Within operators, other actions that have a positive impact on disallowances is having pre-authorized services, well-trained and qualified teams and have disallowance metrics with constant monitoring.

All of this provides good management of glosses on a day-to-day basis and generates benefits for companies impacted on the operator billing, at reduction of financial losses, at elimination of bureaucracy and, also, in less work time involved in managing disallowances.

And now that you understand why good gloss management is important for your operator, let's talk about what the gloss feature is.

What is a gloss feature?

The disallowance resource is a set of evidence and documents that the service provider requests payment from the operator for what was denied.

It is worth mentioning that this non-payment can occur for any reason, such as incorrect nursing notes, lack of medication checks, performance of a procedure outside the contract, among others.

In this way, the service provider does not charge appropriately, whether above or below the amount agreed in the contract, and, as a consequence, the operator analyzes, repairs the error and only passes on what, in its opinion, was actually used. by the patient.

Afterwards, the cancellation is returned to the financial sector of the health institution, which analyzes the items canceled by the operator to check whether it is consistent or not.

At this point, the establishment needs to present the justification for charging, however, in most cases, the cancellation appeal is related to the operators' deadlines, which vary from one plan to another.

The role of an audit system in the disallowance feature

One audit system, such as SAUDI, can help your operator to have a centralized, dynamic and reliable disallowance appeals process.

This is because, by allowing service providers to carry out the resource through our software, all information is stored with the highest technology and reliability and allows your management system to handle information assertively.

With these integrated systems, the provider performs the disallowance feature in a simple and uncomplicated way and its operator has standardized records and information available to analyze and carry out the necessary treatments.

Contact us, learn about our solution and use SAUDI in your healthcare provider.