Appeals Management
Appeals that read like they were written by someone who's won before.
The appeal math is the best-kept secret in healthcare revenue: when denied Medicare Advantage claims are actually appealed, more than half get overturned. The problem was never winnability. It was that nobody had the hours to file.
The Problem
The problem: appeals win — and almost nobody files them.
Payers price in your silence. Every unfiled appeal is a denial that stands by default, and the data says the default is what usually happens.
What We Do
Deliverables, not promises.
- Payer-specific appeal letters maintained per denial reason and plan — not generic templates
- Clinical documentation packets assembled with clinician-informed review on medical-necessity appeals
- First-level, second-level, and external/independent review filings, tracked to decision
- Deadline management — every appeal filed inside its window, every window on a clock
- An appeal-outcome database that compounds: every decision teaches the next appeal
The Difference
How it's different
Appeal letters are arguments, not paperwork. Ours are written against the specific payer's own medical policy and denial rationale, with clinical documentation reviewed by clinical eyes — because a medical-necessity appeal argued in billing language loses.
And we track every outcome. Each overturn or upholding feeds the database that scores the next thousand denials, so overturn-probability estimates get sharper every month.
What It Costs
Performance pricing or a flat rate. Your choice, your state’s rules.
Model A: a percentage of dollars actually recovered — nothing recovered, nothing owed (most states). Model B: a fixed monthly rate where every recovered dollar is 100% yours (all 50 states). Both start with the free Recovery Audit ($500 value) and its written go/no-go.
See both pricing models →Questions
Asked on every call about appeals management.
Do you appeal everything?
No — that's recovery theater. We appeal claims with a reasonable basis and meaningful value. Appeals with no merit waste your credibility with the payer and our time.
Who writes the clinical parts of an appeal?
Appeals citing clinical documentation get clinician-informed review before filing. Medical-necessity arguments are made in clinical terms, not billing codes.
What happens if a first-level appeal is denied?
We escalate: second-level appeal, then external or independent review where the plan and state provide it. Every level is tracked to a final decision you can see.
Know your number before you sign anything.
The Recovery Audit is a $500 analysis — yours free, in writing, with an honest go/no-go. Limited slots each month.
Sources
- 1.Of denied Medicare Advantage claims that ARE appealed, roughly 54–57% get overturned. — Federal MA appeals data / KFF
- 2.Fewer than 1% of patients ever appeal a denial. — KFF analysis