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Claimie

Specialty Groups

High-dollar procedures mean high-dollar denials. The math is bigger in your world.

When the average claim is a procedure, an implant, or an infusion, a single denial can equal a family practice's entire week of denied revenue. Specialty groups don't have a denial-rate problem — they have a denial-severity problem.

You, Specifically

Your revenue concentrates in a small number of high-value CPT codes — which is exactly where payers concentrate their medical-necessity reviews, prior-auth requirements, and downcoding algorithms. One denied procedure isn't a statistic; it's a hole in the month.

And the prior-auth treadmill never stops: your clinicians and staff burn hours per week feeding payer portals for care that's ultimately delivered anyway — then a percentage of it still comes back denied on a technicality.

The Patterns

The denials we see in your world, over and over.

  • Medical-necessity denials on your highest-value procedures
  • Prior-auth denials where the auth exists but numbers, dates, or units don't match
  • Downcoding and bundling edits that shave hundreds per case
  • Medicare Advantage plans denying at rates traditional Medicare never did
  • Implant and invoice-based reimbursement disputes

13 hrs/wk

Average physician/staff time spent on prior authorization tasks1

~$1,000

Average value of a denied Medicare Advantage claim — up 22.4% year over year2

54–57%

MA denials overturned when actually appealed3

The Engagement

What working with us looks like.

  1. 01

    Audit prioritizes your top CPT codes by denied dollars, not claim counts.

  2. 02

    Clinical documentation review on medical-necessity appeals — argued in clinical terms.

  3. 03

    Contract-rate underpayment audit across your top payers, procedure by procedure.

  4. 04

    Monthly root-cause reporting tuned to your specialty's denial taxonomy.

Pricing

High average claim values make the contingency math work strongly in your favor — and make the flat-rate program a rounding error against one recovered procedure. Both models on the Pricing page.

See both pricing models →

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.

Get Your Free Recovery Audit →
Sources
  1. 1.Physicians and staff spend an average of 13 hours per week on prior authorization tasks. — AMA 2024 Prior Authorization Report
  2. 2.The average denied Medicare Advantage claim is now worth about $1,000 — up 22.4% year over year. — MDaudit network data, 2025
  3. 3.Of denied Medicare Advantage claims that ARE appealed, roughly 54–57% get overturned. — Federal MA appeals data / KFF