Services
Denial Management & Appeals
Every denial worked, every pattern traced back to its cause.
What we do
A denied claim is not lost money yet, but it becomes lost money when nobody works it before the filing deadline. Denials also tend to repeat: the same missing modifier, the same eligibility gap, the same payer rule. We work each denial and look for the pattern behind it.
Denial triage
Each denial is sorted by reason, payer, amount and deadline so the most valuable and most time-sensitive claims are worked first.
Root-cause analysis
We identify why the claim was denied, using the reason codes and the claim history, and whether the cause sits at the front desk, in coding, in documentation or with the payer.
Appeal preparation and resubmission
For corrected claims, we fix and resubmit. For appeals, we prepare a clear letter with the supporting documentation the payer needs and track it until there is a decision.
Tracking by payer and reason code
We keep a running log of denials by payer and by reason code, so you can see where revenue is getting stuck.
Zero balance review
A $0 balance is not always final. We audit closed accounts for premature write-offs, incorrect contractual adjustments and carrier underpayments, and pursue what is still owed to you.
Prevention feedback loops
Recurring causes go back to the right person with a specific fix: a new front-desk check, a coding rule or a template change.
Our workflow
- 1
Collect and sort
Denials are pulled from remittances and payer portals and sorted daily.
- 2
Diagnose
We identify the cause and decide whether to correct, appeal or close.
- 3
Act
Corrected claims are resubmitted; appeals are written and sent with documentation.
- 4
Track
Every open denial has a status and a next follow-up date.
- 5
Prevent
Monthly review of top denial reasons, with an agreed fix for each.
What you can expect
These are the standards we work to and report against. They are commitments we aim for, not guarantees, because some steps depend on payers and on information from your practice.
- We aim to review new denials within two business days of receiving the remittance.
- We aim to act on time-sensitive denials well before payer filing deadlines.
- You get a monthly view of denials by payer and reason code. Our team reports overturning 86% of initially denied claims it appeals.
- Each recurring denial reason comes with a recommended prevention step.
- Appeal outcomes depend on the payer; we tell you honestly when an appeal is unlikely to succeed.
Common questions
Find out where your revenue is leaking.
A free, no-obligation review of your claims and payor contracts, explained in plain language.