Transform Denials into Paid Claims in 14 Days or Less
Healthcare Denial Management Services
Reduce claim denials by 65% & recover 95% of lost revenue with our denial management services. 99% clean claim rate for pediatric practices (vs. 78% industry average). 88% of claims are paid within 14 days. Works with PCC, Epic, and other pediatric EHRs. 3-5% of collections or flat $499/month for small practices
The $20 Billion Problem:
Healthcare Denial Management Services
U.S. hospitals waste billions annually fighting claim denials – with the average provider losing $5M per year in unresolved claims (American Hospital Association). These financial leaks directly impact
Revenue Cycles: 12-18% slower collections for denied claims
Staff Productivity: 120+ hours/month spent on appeals
Patient Care: 43% of providers reduce services due to cash flow issues
Why In-House Systems Fail:
Limited Expertise: Most teams lack payer-specific appeal strategies
Tech Gaps: 68% still use manual tracking (spreadsheets/paper)
Resource Drain: Each appeal takes 30-45 minutes of staff time
Private Practices lose 15-30% of their revenue to these preventable issues
Biggest Denial Management Challenges
Complex Payer-Specific Rules
Timely Filing Deadlines
Clinical Documentation Gaps
Staff Turnover Impact
Prior Authorization Errors
Understaffed Appeals Teams
Schedule a Consultation with Our Denial Management Expert
We understand your need to keep things small, intimate, and personalized. Our medical billing specialists for independent small practices thoroughly study your needs and offer custom-made solutions.
Denial Management Services
We Offer
Denial Analysis & Reporting
Our team analyzes every denial code to identify root causes. We prepare detailed reports showing denial trends/patterns (by payer, provider, and service line) and recommend corrective actions.
- Categorize denials by type (technical/clinical)
- Identify top 5 recurring denial reasons
- Monthly benchmarked reports
A/R Recovery Services
Comprehensive follow-up on unpaid claims including:
- Denial investigation and correction
- Resubmission with supporting documentation
- Payment discrepancy resolution
- Aging AR prioritization
We recover an average of 89% of denied claims.
Payer Compliance Management
Ensure claims meet each payer's unique requirements:
- Contractual obligation audits
- Real-time edits for 450+ payer rules
- Modifier/Coding compliance checks
- Pre-submission validation
Reduces preventable denials by 73%.
Claims Rework & Resubmission
End-to-end correction of denied claims:
- Verify original claim errors
- Obtain missing clinical documentation
- Correct coding/billing errors
- Resubmit with audit trail
Average turnaround: 48-72 hours.
Appeals Management
Specialized appeals for unjust denials:
- Level 1-3 appeals
- External review requests
- EOB/remittance analysis
- Clinical validation (RN-supported)
86% overturn rate for medical necessity appeals.
Policy & Procedure Development
Prevent future denials through:
- Root cause analysis audits
- Staff training programs
- Customized denial prevention workflows
- Clean claim rate monitoring
Clients achieve 25% higher FPA rates within 6 months.
Denial Management Services
Process
Our 6-Step Denial Management Process
Identifying the Cause Analysis
The first step in the denial management process is to read the denial letter (with the denial code stated on it) and understand what led to the payer denying reimbursement for the claim.
Key Action: Decipher denial codes (CO, PR, OA)Verifying, Cross-Checking, and Examining
If the denial was the result of incorrect or missing information, then the patient details are verified, cross-checked, and rectified for clean claims submission. Available documents are examined for discrepancies.
Tools: EHR cross-check, insurance verificationGathering Supporting Documents
If the claim was denied due to insufficient documentation, then our experts request the required documents from the provider and attach them with the new or reworked claim for resubmission.
Common Docs: Progress notes, auth forms, NDC codesAppealing the Denial
Denials can be appealed if the decision is unjust and the providers hold the right to accurate reimbursements. Evidence is collected (e.g., EOB and medical necessity letter) to file an appeal and reverse the decision.
Success Rate: 89% appeal overturnsTracking the Results
After the claims are resubmitted and appeals are filed, the team tracks the progress and follows up with the payers. Some payers can approve the reworked claims in 48 hours, while others may take longer.
System: Real-time AR dashboardDevising Prevention Strategies
The last step of our denial management process includes extensive audits and strategy formulations to prevent denials. From training the staff to automating processes, steps are taken to reduce the denial rate.
Result: 62% fewer repeat denialsBenefits of Outsourcing
Denial Management Services
Higher Appeal Success Rates
Specialized knowledge of payer-specific appeal requirements results in 89% overturn rates vs. 52% in-house.
37% More RecoveriesReduced Administrative Costs
Eliminate hiring/training costs for denial staff while gaining 300% more productivity per FTE.
$81k Annual SavingsFaster Cash Flow
Appeals resolved in 14 days avg vs. 42 days internally, accelerating reimbursements.
68% Faster PaymentsPrevent Future Denials
Root cause analysis identifies and fixes 83% of repeat denial patterns.
↓62% Denial RatesCertified Specialists
CPC and CPB-certified teams with 8+ years avg experience in denial resolution.
98% AccuracyReal-Time Analytics
Custom dashboards track 27 KPIs including denial trends by payer, provider, and service.
Data-Driven DecisionsDenial Management Services
FAQs
We maintain an 89% success rate across all appealed claims (vs. 52% industry average). For Medicare Advantage plans, our rate exceeds 93%.
$2.8M recovered last quarterMost clients are onboarded in 5-7 business days. We prioritize claims approaching timely filing deadlines during the first 30 days.
Yes. Our teams specialize in:
- Technical: Coding (CPT/ICD), modifiers, auth issues
- Clinical: Medical necessity, DRG disputes, level of care
Our 5-step analysis:
- Payer-specific trend reports
- Provider-level audit
- Service line focus (e.g., surgery vs. radiology)
- Front-end process review
- Ongoing monitoring with 27 KPIs
We connect with all major systems including Epic, Cerner, Meditech, and NextGen. Typical integration takes 3-5 business days.
HL7 & API options availableTwo transparent options:
- Percentage of Recovered Revenue: 15-25% based on volume
- Flat Fee per Claim: $18-$42 depending on complexity
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Specialties we serve
Family Medicine
Nurse Practitioners
Internal Medicine
Pediatrics
OB/GYN
Pain Medicine
Sleep Medicine
Cardiology
Dermatology
Endocrinology
Gastroenterology
Neurology
Podiatry
Pulmonology
Physical Therapy
Urgent Care
Psychiatry
Anesthesiology
Speech Therapy
Occupational Therapy
Otolaryngology (ENT)
Physical Medicine & Rehab
Geriatrics
Allergy & Immunology
Mental Health Therapists
Nephrology
Ambulatory Surgery Center
Wound Care
Addiction Medicine
Infectious Disease
Denial Management Services
Insurances Covered
Trusted Medical Billing Services
Verified Results
Very attentive and efficient
Always available to explain things or answer questions or concerns
We would love to hear from you.
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We serve all 50 states.
