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HBOK 1-451

Title Reduction in Claims Denials for High-Tech Imaging (HTI) at SMDC Health System Center for Therapy
Author(s) Pam Helgeson-Britton
Source Healthcare Divison
Topic Performance Measurement

Data Analysis

Performance Improvement

Abstract SMDC Health System Center for Therapy was experiencing a higher-than-usual level of claims denials from a number of insurers for high-tech imaging tests (CT and MRI). The claims were being denied because SMDC had not obtained prior authorization for the tests. This resulted in approximately $45,000 in claims denials over a six-month period. A project was launched to reduce denials of claims by 85 percent for high-tech imaging tests ordered by non-SMDC providers.
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Reference Code 1-451

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