Revenue Recovery
Denial Management
Every denial worked within 48 hours and root causes eliminated — because the best denial strategy is preventing the next one.
Denial intelligence
A denial rate you can watch fall
DENIAL PREVENTION DASHBOARD · SAMPLE DATA
LIVEDenial rate · 12 months of managed decline
48 hrs
first touch
65%+
overturned / corrected
31%
prevented pre-submission
Root-cause analysis · where denials come from
160
this month
- Eligibility / registration40%
- Missing authorization22%
- Coding edits18%
- Timely filing8%
- Other / payer error12%
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What this changes for your organization
Denial Management · performance standards
measured continuouslydenial rate achieved for clients
first-touch guarantee
48 hrs
of denials overturned or corrected
Performance standards we operate to. Actual results vary by specialty, payer mix, and starting position — your free assessment establishes your own baseline.
Denials prevented before submission
AI denial prediction scores every claim pre-submission and routes high-risk claims to specialists — 31% fewer denials before prevention even reaches the front desk.
48-hour first touch, guaranteed
Every denial categorized, corrected, and moving again within two business days — measured, reported, and staffed around the clock.
Root causes eliminated for good
Every denial is coded to a cause and fed back upstream — registration fixes, auth workflows, coder education — so the same denial stops recurring.
Appeals that actually win
Evidence-built appeals with policy citations and clinical support overturn 65%+ of what we contest — because we only contest what we can win.
The stakes
The problem, in numbers
The honest diagnosis — what this challenge actually costs healthcare organizations that leave it unmanaged.
~10%
of claims denied at the average practice — and climbing
Payer automation is tightening every year. Practices that treat denials as background noise watch the rate creep upward while margins thin.
60%
of denied claims are never reworked at all
That's earned revenue voluntarily forfeited — care delivered, claim valid, money abandoned because nobody had the time or the process to fight for it.
Repeat
denials are process defects, not bad luck
The same registration gap, the same missing auth, the same coding edit — month after month. Working denials without eliminating causes is bailing a boat with a hole in it.
Wondering what these numbers look like at your organization?
Get a free revenue assessmentOur solution
The average practice never reworks 60% of denied claims — that's earned revenue written off for lack of follow-through. Our denial team touches every denial within 48 hours: categorize, correct, resubmit or appeal, and track to resolution.
Resolution is only half the service. Every denial is coded to a root cause — registration error, missing auth, coding mismatch, payer behavior — and we fix the upstream process so the same denial stops recurring. Clients typically see denial rates fall below 5%.
What's included
- 48-hour first touch on every denial
- Root-cause categorization and trending
- Corrected claim resubmission
- Upstream process fixes to prevent recurrence
- Payer-specific denial pattern tracking
- Monthly denial scorecard by cause and payer
In the field
How organizations like yours use it
USE CASE 01
A behavioral health network went from 22% to 5.2% denials
Root-cause analysis showed authorization and enrollment gaps driving over half the denials. Fixing the upstream workflows — not just appealing harder — collapsed the rate in seven months.
USE CASE 02
An orthopedic group ended its surgical claim denial streak
Global-period modifier errors were denying 13% of surgical claims. Modifier discipline at coding plus targeted appeals on the backlog recovered the revenue and killed the pattern.
USE CASE 03
A family practice automated its eligibility denials away
40% of its denials traced to coverage surprises. Batch verification 48 hours pre-visit eliminated the category — the practice now sees eligibility denials in single digits per month.
Scenarios drawn from typical engagement patterns; identifying details anonymized to protect client confidentiality.
Common questions
Denial Management, answered
Related
More in Revenue Recovery
Ready to fix denial management for good?
Start with a free consultation and billing health check. A senior consultant will look at your numbers and give you a straight answer about what we can improve — and by how much.