We analyze every denial, identify root causes, and file systematic appeals — recovering 85–95% of appealed claims that most practices simply write off as lost revenue.
The average practice has a 10–20% denial rate — and writes off 50–65% of denied claims without appeal. That is millions of dollars in lost revenue sitting in your denial queue. With the right system, 85–95% of denied claims can be recovered.
Our denial management team does not just resubmit — we identify patterns, fix root causes, and implement front-end improvements that reduce your denial rate over time. We also file formal appeals with clinical documentation support for medical necessity denials.
Every detail handled by certified professionals — so you can focus on patient care, not paperwork.
Every denial categorized by type — coding, eligibility, authorization, timely filing — and root cause addressed to prevent recurrence.
Correctable denials fixed and resubmitted within 48 hours, while the clock is still favorable for timely filing deadlines.
Complex denials receive formal written appeals with supporting clinical documentation, medical policy references, and legal precedent when needed.
Clinical staff-supported appeals for medical necessity denials, with physician peer-to-peer review coordination when required.
Monthly denial analytics show your top denial codes, payer-specific patterns, and concrete steps to reduce future denials.
We work with your front desk and clinical team to implement upstream fixes — eligibility checks, authorization workflows, and coding improvements.
A proven, systematic process that maximizes collections at every step of the revenue cycle.
All denials pulled daily from ERA/EOB and payer portals, categorized by type and priority.
Each denial analyzed: coding error, eligibility issue, authorization gap, timely filing, or medical necessity.
Appeals drafted with appropriate documentation — corrected claims, clinical records, or formal appeal letters.
Payment recovered; root causes communicated to your team to prevent the same denial pattern from recurring.
Common questions about our denial management services from healthcare providers nationwide.
Best-in-class practices maintain denial rates below 5%. The national average is 10–15%, and some practices see 20–30% denial rates. We target getting your denial rate to 5% or below within 90 days.
Timely filing limits vary by payer: Medicare allows 120 days from the initial denial; most commercial payers allow 90–180 days. We monitor all deadlines and prioritize appeals accordingly.
We appeal all appealable denial types: medical necessity, coding disagreements, authorization-not-obtained, untimely filing, coordination of benefits, and incorrect patient information denials.
Yes. We conduct retrospective denial reviews and can recover claims denied within the past 12–18 months depending on payer timely filing limits. Many practices recover significant revenue from aged denial backlogs.