Revenue Cycle: Introduction to Claim Denials



This course will build the learner’s core knowledge related to claims processing, payer standardized communications, denials analysis and organizational denials prevention strategies. Learning will begin with a discussion of denials, the claims cycle, and clean claims. Moving on, learners will learn how payers communicate and talk about two main categories of denials. The course will round out with tips and guidance on effective denials prevention strategies healthcare organizations can implement.

Learning Objectives

  • Define a denial
  • Outline the benefits of clean claim submission
  • Explain the difference between a claim rejection and a denial
  • Explain the role of a clearinghouse
  • Identify the standardized codes used in payer communications and
  • Explain the two main types of claim denials
  • Practice root cause analysis by working through a few common denials
  • Evaluate strategies and tools you can utilize to shift your organization into denials prevention mode

Target Audience

  • Billing professionals
  • Revenue integrity professionals
  • Charge master analysts
  • Practice managers

CE Credits

This program has been approved for 1 continuing education units for use in fulfilling the continued education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.

This program has the prior approval of the American Academy for Professional Coders (AAPC) for 1 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Purchasing Details

  • Upon purchase, you will have a 6-month subscription to this course. This will allow you the opportunity to complete and review as often as you like for 6 months.
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