Denial management services that recover revenue and prevent repeat denials
A denied claim isn't lost money yet. We work every denial quickly, appeal the ones worth fighting, and trace each one back to its cause so the same problem stops showing up.
How we handle denied claims
Many practices only resubmit denials, or don't work them at all because there's no time. Unworked denials turn into write-offs once the payer's filing or appeal deadline passes. We treat every denial as two jobs: get this claim paid, and stop the next one.
Triage
Denials are sorted by reason, payer, value and deadline, so the most urgent and valuable are worked first.
Correct and resubmit
Fixable errors such as demographics, codes or missing information are corrected and resent quickly.
Written appeals
Medical necessity and policy denials get a written appeal with supporting documentation.
Root-cause tracking
Each denial is tagged by cause, such as eligibility, authorization, coding or timely filing, and trended monthly.
Upstream fixes
Patterns go back to the step that caused them, whether that is front desk, coding or charge entry.
Payer follow-up
Calls and portal checks on appeals until each one is resolved.
The most common denial reasons we fix
| Denial reason | Usual cause | How we prevent it |
|---|---|---|
| Coverage terminated or not eligible | Insurance not checked before the visit | Eligibility checks before every appointment |
| Authorization required | Prior auth missing or expired | Authorization tracking linked to the schedule |
| Medical necessity not met | Diagnosis doesn't support the service | Coding review against payer policy |
| Bundled or duplicate service | Missing or wrong modifier | NCCI and modifier checks before submission |
| Timely filing | Claim submitted or resent too late | Daily submission and deadline alerts |
| Missing or invalid information | Incomplete registration or charge data | Front-end and scrubber checks |
What you see each month
- Denial rate by payer, by reason and by provider.
- Dollars recovered through resubmissions and appeals.
- The top three root causes and what we're doing about each.
Frequently asked questions
How fast do you work a denial?
Denials are reviewed as soon as they are posted. Simple corrections are usually resubmitted within a few business days, and appeals are prioritized by deadline and value.
Can you work old denials from before we joined?
Yes. As part of an A/R cleanup we review older denials that are still within the payer's appeal window and pursue the ones that can still be recovered.
Do you appeal to Medicare and Medicaid?
Yes. We file appeals with Medicare contractors, Medicaid programs and commercial payers, following each payer's appeal levels and deadlines.
Often paired with denial management
Find out where your practice is losing revenue
Book a free, no-obligation practice review. We look at your claims, denials and A/R and send you a written summary of what we would fix first.