Denial Management
Every denial triaged, root-caused, and worked within 48 hours.
Denials don't lose because they lack merit. They lose because they sit. Our denial management service puts a 48-hour clock on every new denial — triaged, scored, and either worked or escalated before it starts aging toward a deadline.
The Problem
The problem: denial rates keep climbing, and staff time doesn't.
Denial rates have risen every year since 2022. Each denial costs real staff time to fight — which is exactly why more than half are never fought at all. The pile grows faster than any front office can work it.
What We Do
Deliverables, not promises.
- 48-hour triage SLA on every new denial
- Denial-code taxonomy mapping — every CARC/RARC translated into a root cause and an owner
- Worklists ranked by overturn probability, dollar value, and deadline proximity
- Payer-specific resolution playbooks: correct-and-resubmit, appeal, or escalate
- Weekly status report — what came in, what was worked, what was recovered, what's pending
The Difference
How it's different
Most denial 'management' is a queue nobody empties. Ours is triage by math: AI reads every remit line and scores every denial the day it lands, so specialist hours go to the claims where they change the outcome.
And because we work behind your existing billing team — not instead of it — nothing about your workflow changes. We take the exceptions pile; your team keeps the clean claims moving.
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 denial management.
Does this replace our billing team or billing company?
No. Your team keeps submitting claims and posting payments exactly as they do now. We take only the denials — the exceptions pile that never gets time.
How fast do you start working new denials?
Within 48 hours of a denial appearing in your remits, it's triaged, root-caused, and either queued for correction, appeal, or escalation.
What does it cost?
Either a percentage of what we actually recover (Model A, most states) or a flat monthly rate (Model B, all 50 states). See the Pricing page — both models start with the free Recovery Audit, a $500 analysis we run at no charge.
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.Initial claim denial rates hit 11.8% in 2024, up from ~10.2% a few years earlier. — Industry claims data, 2024
- 2.41% of healthcare providers report denial rates of 10% or higher — a figure that has risen every year since 2022. — Experian Health, State of Claims 2025
- 3.50–65% of denied claims are NEVER reworked or resubmitted. — MGMA