Appeals & Recovery

Denial Management & Appeals

Denials analyzed, corrected, and resubmitted within 48 hours. We track root causes across every denial to prevent them from recurring — and recover 30–50% more from aging AR than industry average.

48hr
Denial correction & resubmission
50%
More AR recovered vs. industry avg
97%
First-pass rate — preventing most denials entirely
Our Denial Strategy
We don't just fix denials — we stop them:
48-hour denial review & correction
Root-cause analysis for every denial
Payer appeal letter preparation
Medical records submission support
Denial pattern tracking & reporting
Process redesign to prevent recurrence
Key Benefits

We Fight Until Every Dollar Is Recovered

48-Hour Resolution

Every denial is reviewed, corrected, and resubmitted within 48 hours of receipt — keeping your AR clean and your cash flow moving.

Root-Cause Analysis

We don't just fix each denial — we investigate why it happened and redesign your process to prevent the same denial from recurring.

Professional Appeal Letters

Our team prepares fully documented, payer-specific appeal letters with supporting clinical documentation to maximize overturn rates.

Denial Pattern Reporting

Monthly denial trend reports identify your top denial reasons, payers, and providers — giving you actionable data to improve performance.

Aging AR Recovery

We pursue old, ignored, or written-off denials that other firms abandon. Persistent follow-up recovers 30–50% more from aging AR.

Payer Conflict Resolution

We handle payer policy disputes, peer-to-peer reviews, and external appeals internally — so your staff never has to deal with difficult payer conversations.

Our Process

From Denial to Paid — Fast

01

Denial Identification

Denials are identified through ERA/EOB review and clearinghouse reports — typically within 24 hours of payer adjudication.

02

Denial Analysis

Each denial is categorized by type (coding, eligibility, medical necessity, authorization, etc.) and assigned to the appropriate specialist.

03

Correction & Documentation

The claim is corrected, additional documentation gathered, and an appeal letter prepared if required — all within 48 hours.

04

Resubmission or Appeal

Corrected claims are resubmitted electronically. Appeals are filed through the appropriate payer channel with full supporting documentation.

05

Root-Cause Prevention

Denial data is tracked monthly. Recurring patterns trigger process changes upstream — in coding, eligibility, or documentation — to stop them from happening again.

FAQ

Common Questions

We handle all denial types — coding denials (invalid CPT/ICD, modifiers), eligibility denials, medical necessity denials, authorization denials, duplicate claim denials, timely filing denials, and payer-specific policy denials.
Our appeal overturn rate varies by denial type and payer, but on average our clients see 70–85% of appealed claims overturned. Medical necessity and coding appeals tend to have the highest success rates with proper documentation.
Timely filing denials are among the most preventable. We audit your processes to ensure no claims fall outside filing windows. For legitimate timely filing denials, we submit proof of timely filing or invoke applicable exceptions.
Yes. We handle Medicare Redeterminations, Reconsiderations, and ALJ appeals, as well as state-specific Medicaid appeal processes across all states.
We never write off a claim without your approval. We exhaust all appeal levels and recovery options before recommending a write-off — and even then, we document the reason so it can be used to prevent future occurrences.
Ready to Get Started?

Let’s Find the Revenue
Your Practice Is Missing

Start with a free, no-obligation 2-week audit. Most practices uncover $100K–$500K in recoverable revenue.