Denials fixed at the root, not just resubmitted
We work every denial by its reason code, correct and resubmit or appeal it within the payer’s deadline, and fix the process that caused it so it stops happening.
What’s included
- Denial worklist by CARC/RARC reason, payer and provider
- Corrected claims and reconsiderations
- Written appeals with supporting documentation
- Medicare redeterminations and reconsiderations
- Medical necessity and authorization appeals
- Monthly denial trend report with root causes
How we handle it
Sort
Denials grouped by reason, payer and dollar value.
Fix or appeal
Correct and resubmit, or appeal with documentation.
Track
Each appeal tracked to a decision.
Prevent
Front-end fixes for the top denial causes.
Details that matter
Denials come in a few families: eligibility and registration, authorization, coding and bundling (for example NCCI edits or a missing modifier 25 or 59), medical necessity, timely filing and duplicate claims. Each family has a different fix.
Appeal deadlines are strict. For Medicare, a redetermination must be requested within 120 days of the initial determination. Commercial plans set their own limits, often 60 to 180 days.
Questions about denial management
What is a good denial rate?
Many well-run practices aim for an initial denial rate under 5 to 10 percent. We measure yours and target the biggest causes first.
Do you write appeal letters?
Yes. We prepare appeal letters with the clinical documentation and payer policy references needed.
See where your revenue is going.
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.