The average practice has $50,000-$200,000 in denied claims sitting in their system right now that nobody is working. Every day those claims age, recovery gets harder and filing deadlines get closer. We recover the revenue your billing team gave up on.
Medical claim denials aren't rare events. They're a constant, predictable drain on your revenue. The national average denial rate is 5-10%, which means a practice billing $2M per year has $100,000-$200,000 in denied claims annually. The question isn't whether you have denials. It's whether anyone is doing anything about them.
The root cause is almost always the same: the billing team is too busy submitting today's claims to work yesterday's denials. New claims generate immediate revenue. Appealing old denials generates revenue in 60-90 days. When staff bandwidth is limited, the denials lose every time. The backlog grows. Filing deadlines pass. Revenue disappears.
This isn't a people problem. It's a systems problem. And it's exactly the problem our AI-powered denial management system was built to solve.
We don't just process your denials. We deploy an AI-driven system that identifies why denials happen, prioritizes which ones to fight first, and prevents them from recurring. Here's the process:
Before we touch a single claim, our AI scans your entire denial history and clusters failures by payer, code, and reason. It finds the patterns your team can't see in spreadsheets, like Aetna denying your 99214s at 3x the rate of United, or a credentialing gap causing silent CO-185 rejections across an entire provider.
Every denied claim in your system gets scored by dollar value, filing deadline proximity, and historical appeal success rate. We attack the highest-ROI claims first. A $3,000 surgical claim expiring in 15 days gets worked before a $45 lab claim with 60 days remaining. This isn't guessing. It's math.
Every future claim passes through our pre-submission scrubber before it leaves your system. Payer-specific modifier rules, bundling logic, NPI accuracy, documentation requirements. The errors that would become denials in 30 days get caught before they cost you money. That's why our clients maintain a 96% clean claim rate.
Monthly reports breaking down every denial by payer, code, reason, and provider. Not just what was denied, but why, and what changed to cause it.
Every appeal written to the specific payer's requirements. UHC appeals look different from Aetna appeals. We know each payer's language, documentation thresholds, and escalation paths.
We audit your existing denied claims backlog from the last 6-18 months and recover everything still within filing deadlines. Most practices find $40,000-$150,000 in recoverable revenue.
AI-powered scrubbing catches coding errors, missing modifiers, NPI mismatches, and bundling conflicts before claims are submitted. Prevention is cheaper than recovery.
Payers sometimes apply incorrect contractual adjustments (CO-131) that don't match your fee schedule. We audit payments against contracted rates and recover the difference.
Live tracking of your denial rate, appeal status, recovery amounts, and clean claim rate. Not a monthly PDF. A dashboard you can check any time that shows exactly where your money is.
Provider enrollment lapses are the #1 cause of CO-185 denials. We track every provider's enrollment status with every payer and alert you before gaps cause denials.
12:1 client-to-staff ratio means your account manager actually knows your practice, your payers, and your providers. Direct phone and text access. Answers in hours, not days.
These are the codes that drain the most revenue from private practices. Each one has a specific fix. If you're seeing any of these regularly, your denial management system has gaps.
| Code | Description | Typical Cause | Our Fix |
|---|---|---|---|
| CO-185 | Provider not eligible | Credentialing lapse or NPI mismatch | Enrollment monitoring + retroactive credentialing |
| CO-21 | Missing information | Incomplete claim fields or missing auth numbers | Pre-submission scrubbing catches before send |
| CO-49 | Invalid procedure code | Outdated CPT codes, especially after Jan 1 updates | Quarterly code set validation |
| CO-131 | Incorrect contractual adjustment | Payer applying wrong rate per contract | Payment vs. contract audit with variance alerts |
| CO-26 | Expenses incurred prior to coverage | Eligibility not verified at time of service | Real-time eligibility verification protocol |
| CO-140 | Patient/insured ID mismatch | Typo in member ID or name discrepancy | Automated ID validation before submission |
Use our Denial Code Lookup Tool to search any of the 106 denial codes in our database with plain-English causes and step-by-step fixes.
Denial management is included in our full RCM service starting at 4.9% of net collections. We only get paid when you get paid. No setup fees. No contracts. No minimums.
Already have a billing company but need denial help? We offer standalone denial management for practices that want to keep their current biller but need specialized help with their denial backlog and prevention. Contact us for standalone denial management pricing.
Denial patterns vary by specialty. A dermatology practice's top denials (Modifier 25, destruction code sequencing) look nothing like a cardiology practice's top denials (component billing, nuclear study authorization). Our team has specialty-specific expertise across:
AWV coding, CCM revenue capture, preventive vs. problem visit splitting
Component billing (Mod 26/TC), nuclear study authorization, interventional coding
Modifier 25 optimization, destruction code sequencing, biopsy coding
Telehealth modifier compliance, 90837 prior auth tracking, parity enforcement
Global period tracking, multiple procedure sequencing, assistant surgeon modifiers
Medicare compliance, CCM/TCM billing, AWV documentation requirements
We'll analyze your denial history and show you exactly how much is recoverable, which payers are causing the most damage, and what it would take to fix it. Free. No commitment.
We'll send your denial analysis within 48 hours.