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Service
Denial Management
Most billing companies file denials. We fix them. Every rejection that comes back is reviewed, categorized, researched, and worked to resolution, with the root cause tracked and corrected so the same denial doesn’t repeat next month.
Who this is for
- Practices with growing A/R backlogs
- Providers experiencing repeat denial patterns
- Practices switching from a biller who wasn’t following up
- Any practice leaving money on the table due to unworked denials
Pain points
A denial isn’t a dead end. It’s a missed follow-up.
Most practices lose revenue not because claims get denied but because nobody works the denial once it comes back. Here’s what that looks like.
Denials sitting unworked
Rejections get acknowledged and filed but never actually fixed. The same denial reason comes back month after month because nobody is tracking the pattern or correcting the root cause.
Appeal windows closing
Every denial has a deadline. When nobody is working the queue daily, balances age past 90 and 120 days and the appeal window closes before anyone looks at it.
Revenue written off too early
Claims get written off as uncollectable before every recovery option has been exhausted. That’s not a payer decision. That’s a follow-up decision.
What’s included
Every denial worked until it’s resolved.
01
Denial identification & capture
Every rejection and denial monitored across clearinghouse and payer responses, captured with the denial reason, claim number, date, payer, and dollar amount.
03
Priority-based work queue
Denials prioritized by dollar value, appeal deadline, age of A/R, and probability of recovery. High-value denials approaching their deadline get worked first.
05
Claim correction & resubmission
Corrected claims resubmitted with updated information, corrected coding, and any required documentation attached. Nothing gets rebilled without being fixed first.
07
Resolution posting & reporting
Every resolved denial posted, documented, and reported. You see what was recovered, what was written off, and why, with patterns flagged so upstream fixes can be made.
02
Denial categorization
Each denial categorized by type, timely filing, medical necessity, coding, eligibility, authorization, and more, so the right fix gets applied the first time.
04
Root cause research
Every denial researched back to its source, patient demographics, eligibility, authorization, coding, payer policy, and prior claim history, so the fix addresses the cause, not just the symptom.
06
Appeal submission & follow-up
Appeals submitted with full documentation and tracked through to resolution, with follow-up dates, payer reference numbers, and expected response timeframes recorded.
Most denials have a 90-to-120-day appeal window.
We start working them the day they come back, not at month-end.
How it works
From denial to resolution, every time.
We don’t just resubmit and hope. We research, correct, and track every denial through to a documented outcome.
1
Identify the Denial
We monitor clearinghouse and payer responses daily, capture every rejection and denial, and record the denial reason, date, claim number, payer, and dollar amount.
2
Categorize & Prioritize
Each denial is categorized by type and prioritized by dollar value, appeal deadline, age of A/R, and probability of recovery so the highest-impact denials get worked first.
3
Research the Claim
We research back to the root cause, reviewing patient demographics, eligibility, authorization, coding, modifiers, payer policy, and prior claim history to determine exactly what went wrong.
4
Correct & Resubmit
The claim is corrected at the source, whether that’s a coding error, missing documentation, or wrong patient information, and resubmitted clean.
5
Appeal & Follow Up
Appeals are submitted with full documentation and tracked through to resolution. Every appeal has a reference number, follow-up date, and expected response timeframe on record.
6
Post & Document the Resolution
Every resolved denial is posted, the account corrected if needed, and the final outcome documented. Patterns are flagged so the same denial doesn’t get built into next month’s claims.
The outcome
What changes when denials actually get worked.
Less
Revenue written off, because every denial gets researched and worked before the appeal window closes.
Fewer
Repeat denials, because root causes get fixed upstream instead of the same error recurring month after month.
Faster
Resolution, because denials are prioritized by value and deadline, not left in a queue nobody checks.
More
Recovered revenue, because nothing gets written off until every recovery option has been exhausted.
“Sherry, Christine and the rest of the staff are an absolute pleasure to work with. They have made the process of billing insurance companies so much easier. The level of knowledge, understanding, and commitment to finding a better way forward is incredible!”
Patrick Murphy
Owner, Reliable Medical Transportation · Brighton, MI
Questions
Before you ask.
How far back do you go on denied claims?
We review your full A/R during discovery and identify what is still within the appeal window and what is recoverable. Legacy denials are scoped clearly so you know exactly what is being pursued and on what terms.
What denial reasons do you handle?
We handle all denial types including timely filing, medical necessity, coding errors, eligibility issues, authorization problems, and administrative denials. Each one gets researched to its root cause, not just corrected on the surface.
Do you fix the root cause or just resubmit?
Both. We correct and resubmit the claim, and we track the root cause, so the same denial doesn’t get built into next month’s billing. Resubmitting without fixing the source is how the same denial repeats month after month.
Will we have a specific person to contact?
Yes. You get a named team that knows your practice and your payers, and you can reach them directly. Most practices come to us because they couldn’t get anyone on the phone.
How is this priced?
Pricing is scoped to your practice after the discovery review, based on volume, specialty, and which parts of the cycle we’re taking on. We walk you through it in detail before anything is signed, no surprise line items.