A denial rate is a number you can only watch. Denials grouped by reason code, payer, and provider are a number you can act on — and the same three causes usually account for most of the money.
Denials get worked in the order that recovers the most money, and the causes get reported back to the people who can prevent them.
At a glance
Step 1
Work denials by reason code and dollar value rather than in queue order
Step 2
File corrected claims and appeals as the distinct transactions they are
Step 3
Assemble the documentation an appeal needs before it is submitted
Step 4
Track appeal outcomes by payer so effort goes where it succeeds
What we actually do
- Work denials by reason code and dollar value rather than in queue order
- File corrected claims and appeals as the distinct transactions they are
- Assemble the documentation an appeal needs before it is submitted
- Track appeal outcomes by payer so effort goes where it succeeds
- Report denial causes monthly so upstream fixes actually happen
What this fixes
- A denial queue worked oldest-first regardless of recoverability
- Resubmissions that create duplicates and restart nothing
- The same denial reason recurring every month with nobody tracing it
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at how this runs today and where it leaks.
Scope
A written scope and price before any work starts.
Transition
We take it over without a gap in submission.
Report
The same six numbers every month, so you can see it working.
Denial Management & Appeals — Frequently Asked Questions
Do you appeal every denial?
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No. Some denials are correct and some are past appeal. We work the ones that are recoverable and tell you which are not, rather than billing effort against claims that cannot pay.
Who writes the appeal?
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We do, using your documentation. We do not represent you in a payer or government audit — that is a different thing and we refer it out.
How is denial management & appeals priced?
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It is included in ongoing revenue cycle management, which is priced as a percentage of collections banded by practice size — or as a flat monthly fee in states that do not permit percentage compensation of a billing company. Front-end services are also available on their own, per occurrence, without a billing contract.
Do you guarantee a result from denial management & appeals?
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No, and nobody honestly can. Coverage, adjudication, payment amounts and appeal outcomes are decided by the payer. What we commit to is the process and the six numbers reported every month, all of which you can reproduce from your own practice management system rather than take on trust.
Can we buy denial management & appeals without moving all of our billing?
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Front-end services are sold per occurrence and stand alone. The back-end work is harder to separate — denial management without control of coding and submission means inheriting problems created upstream — but we will say plainly which parts make sense on their own rather than sell a partial engagement that cannot succeed.
Ready for books you can actually trust?
Book a free consultation and we will tell you what your revenue cycle needs and what it costs.
- Done-for-you
- Solo or group
- Nationwide
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