Claim Denial Management and Appeals
We work every denial, appeal what's recoverable and fix the root cause so it doesn't happen again.
Denial review and categorization by reason code
Corrected claims and written appeals with documentation
Follow-up with payers until each claim is resolved
How We Help
A denied claim isn't lost money until nobody works it. Busy practices often let denials pile up: the reason codes are confusing, appeals take time and the deadline passes quietly. We work every denial your practice receives, correct and resubmit what can be fixed, write appeals for what should have been paid, and track the patterns so the same denial stops coming back.
Every client gets a dedicated billing team, clear monthly reporting and direct access to our specialists by phone and email.
What's included
- Denial review and categorization by reason code
- Corrected claims and written appeals with documentation
- Follow-up with payers until each claim is resolved
- Timely-filing and appeal-deadline tracking
- Backlog recovery for aged denials
- Root-cause analysis and monthly trend reports
How we handle every denial
- Categorize. Each denial is sorted by its claim adjustment reason code (CARC) and remark code, payer, provider and dollar value.
- Prioritize. The highest-value and closest-to-deadline claims are worked first.
- Fix or appeal. Front-end errors such as a wrong member ID, missing modifier or coordination of benefits issue are corrected and resubmitted. Clinical or policy denials get a written appeal with supporting documentation.
- Follow up. We stay on each claim with the payer, by portal and by phone, until it is paid or properly closed.
- Prevent. Monthly trend reports show which denials repeat and what to change to stop them.
Common denials we resolve
| Code | What it means | How we fix it |
|---|---|---|
| CO-16 | Claim is missing information | Add the missing data and resubmit |
| CO-197 | Prior authorization missing | Request retro-authorization where allowed, or appeal with records |
| CO-50 | Not medically necessary | Appeal with notes and coverage policy (LCD/NCD) support |
| CO-97 | Service bundled into another | Review NCCI edits; appeal with the correct modifier if separately payable |
| CO-4 | Modifier missing or inconsistent | Correct the modifier and resubmit |
| CO-22 | Another payer may be primary | Confirm coordination of benefits and bill the right payer |
| CO-27 | Coverage had ended | Verify eligibility and bill the correct payer or the patient |
| CO-29 | Timely filing limit passed | Appeal with proof of timely submission, such as clearinghouse reports |
| CO-18 | Duplicate claim | Check claim status before resubmitting; appeal if it was processed incorrectly |
Appeal deadlines we track
Every payer has its own appeal window, and a missed deadline usually means the money is gone. For Medicare, a first-level appeal (redetermination) must be filed within 120 days of the initial determination. Texas Medicaid managed care plans and commercial payers each set their own windows, often between 60 and 180 days. We track every deadline in your account so appeals go out on time.
Backlog recovery
If you already have months of unworked denials, we can take on the backlog alongside your current claims. We sort it by dollar value and remaining appeal time, recover what can still be recovered, and give you an honest list of what is past saving and why.
Stopping denials at the source
The cheapest denial is the one that never happens. Most denials trace back to a few front-end problems: eligibility that wasn't checked, authorizations that weren't obtained, or coding that didn't match documentation. Our monthly report links each denial to its root cause and gives you a short list of fixes, such as verifying eligibility before every visit or adding an authorization check for specific procedures.
Related: A/R follow-up · Eligibility verification · Prior authorization · Coding services · Top reasons medical claims are denied · Timely filing limits
What clients see when billing runs well
01Can you work old denials and aging A/R?
Yes. We can take on a backlog of aged claims and denials, prioritizing by dollar value and how much appeal time is left.
02What is a normal denial rate?
Industry figures generally put initial denial rates somewhere between 5% and 15% of claims. Your monthly report shows yours and how it is trending.
03Do you write the appeal letters?
Yes. We draft and submit every appeal, and only ask your providers for clinical records or a signature when the payer requires it.
04Can we use denial management without full billing?
Yes. Denial management and backlog cleanup can be used on their own or as part of our full billing service.
Keep the whole cycle moving
Eligibility Verification
We confirm coverage, benefits, copays and authorization needs before the visit, so claims aren't denied for preventable reasons.
Learn more →Compliance With Regulations
HIPAA-compliant processes, payer-rule monitoring and documentation checks that keep your practice audit-ready.
Learn more →Claims Processing
Clean claims scrubbed, submitted electronically and tracked until they are paid.
Learn more →Ready to Get Paid Faster?
Get a free billing review. We'll look at your current collections, denials and A/R and show you where revenue is being lost.