Pain Management
Score every interventional claim before it denies.
Pain management practices face some of the highest denial rates in specialty care. Authorization failures on CPT 64483, bundling violations on CPT 64635 and 64636, and deleted ICD codes repeat cycle after cycle because nobody sees the pattern before submission.
Request a DemoWhat Prexisio surfaces for pain management practices.
The Claim Risk Predictor catches issues before submission. The Pattern Report surfaces the structural patterns after adjudication.
Authorization failures on interventional procedures
Aetna PPO, UHC, and commercial plans deny a disproportionate share of CPT 64483, 64490, 64493, and 64635 claims for missing or invalid prior authorization. The Claim Risk Predictor flags these before submission so the billing team obtains authorization before the claim leaves the system.
Deleted and unspecified diagnosis codes
ICD-10 codes that were deleted from the current code set trigger automatic CO-11 denials regardless of the procedure or payer. Prexisio's pre-check layer catches these before any scoring occurs and blocks the claim from submission.
Timely filing violations on older claims
Pain management practices often carry service dates from previous periods. Claims submitted after the payer's timely filing window will receive CO-29 denials with no appeal path. Prexisio flags these as CERTAIN DENIALS before submission.
Payer-procedure denial patterns
The Pattern Report names the specific payer-CPT combinations driving the highest denial rates in this practice's history. Aetna PPO and CPT 64483 at 42%. UHC and CPT 64635 at 35%. Named patterns, not aggregate categories.
Underpayment on paid interventional claims
A payer accepting the claim is not the same as a payer paying the contracted rate. Prexisio detects payers where the actual payment ratio is more than seven points below the expected rate for the plan type and flags them for contract audit.
Multi-site and multi-payer visibility
Pain management practices often operate across clinic and ASC settings with different payer mixes at each site. The Pattern Report surfaces denial and underpayment patterns across all sites, providers, and payers in the adjudicated history.
The questions Prexisio answers for your practice.
Claim Risk Predictor
- Which claims in this batch are likely to be denied by Aetna, UHC, or Medicare?
- Which claims carry deleted ICD codes or timely filing violations?
- Which CPT 64483 and 64490 claims are missing authorization?
- What does the billing team need to do for each HIGH risk claim before submitting?
Pattern Report
- Which payer-CPT combinations are denying at the highest rates in this practice?
- Which payers are paying below the contracted rate on paid interventional claims?
- What are the four most important revenue actions for the billing director this period?
- Where is the denial rate above the 15% industry benchmark and why?
What Prexisio needs from your practice.
Adjudicated Claims History
12 months of paid and denied claims with CPT, ICD, modifier, payer, billed, allowed, paid, and denial reason
Pre-Submission Batch
The claims file the billing team is preparing to submit — exported from the practice management system
No EHR integration. No dashboard adoption. The analyst uploads the files and returns the scored work order and Pattern Report.
See the Claim Risk Predictor scored on your pre-submission batch.
Share 12 months of adjudicated claims. Prexisio trains the pattern model and returns a scored work order for your next submission cycle.
Request a Demo