Denial management
Denial management for claims that came back
We work out why the claim was denied and what has to go back to the payer, with the deadline in view. Our billers write it up, and they review whatever the payer will see.
It's free, and you can keep your current biller
Why denials pile up
A denial shows up as a code on a remittance, something like CO-197 or CO-16, and the code won't tell you which authorization was missing or which field was wrong. Somebody has to open the claim and the chart, figure it out and resubmit, usually on a day when the waiting room is full, so the small office visit denial gets set aside first.
The same few causes also keep coming back. If one plan's referral requirement keeps getting missed at the front desk, you'll see that denial next month and the month after, and nobody connects them unless someone's keeping count.
How we handle denials
- Find the causeWe read the claim adjustment and remark codes next to the claim itself, since the code on its own rarely tells you the whole story.
- Pick the routeA corrected claim, a reconsideration and a formal appeal each have their own rules and deadlines, so we recommend the one that fits the denial.
- Draft the appealA biller writes the letter, pulls the supporting documents from your records and reads the whole thing again before it goes out.
- Watch the deadlinesWe log each denial with its timely filing and appeal dates, and the closest ones get worked first.
- Fix it upstreamWe track outcomes by reason and payer, then tell you what to change at the front desk, in coding or in enrollment to cut down on repeat denials.
How it runs
- 1
Sort the pile
We group denials by reason and payer, then by dollar value and deadline.
- 2
Work the claims
Billers fix and resubmit or file an appeal, starting with what's most urgent and worth the most.
- 3
Report repeat causes
Anything that keeps coming back goes in your monthly report with a specific recommendation.
How this is priced
Denial work can be part of full service billing, or you can buy it on its own. On its own, recovery is generally priced as a percentage of eligible recovered amounts, where permitted.
How our pricing worksDenial management questions
What people ask about this
Can you work denials without replacing our current biller?
Yes. That's what the 30 day denial recovery pilot is for. You can judge the work before you decide anything bigger.
What do you need from us to appeal a denial?
Mostly access to the chart, plus any authorization or referral paperwork that goes with the visit. If something's missing, we'll ask your office for it, and if the record doesn't support the appeal, we won't send it.
Will you change our codes to get a claim paid?
No, not unless the documentation supports the change. If the note doesn't support the code, we take it to the provider, and the provider decides.
How far back can you go?
It depends on each payer's filing and appeal limits. The audit shows which denied claims are still inside their windows and worth pursuing.
Find out what your claims are leaving behind
Send us your denial and A/R reports and you'll have a written report within 48 hours, for free. You can keep your current biller while you decide.
