Eligibility and authorization
Review inactive coverage, incorrect insurance, and missing or insufficient authorization information.
The bigger picture
A stronger revenue cycle starts with the details.
A denied claim does not always mean the revenue is lost. We review why a claim was denied, determine the appropriate action, and follow up with payers while identifying patterns that can help prevent repeat issues.
A structured denial process connects claim resolution with trend analysis and prevention.
Built around your needs
What’s included
- Denial identification and detailed claim review
- Root cause analysis
- Claim correction and resubmission
- Appeal preparation and supporting documentation
- Payer follow-up and appeal status tracking
- Denial prioritization and deadline monitoring
- Denial reporting and prevention
We agree on the exact scope, responsibilities, and reporting with your practice before work begins.
A closer look / 01
Common denials we handle
Coding and missing information
Identify coding, modifier, patient detail, or documentation issues requiring correction or further review.
Timely filing
Review claim history and available information to determine whether further action or an appeal is appropriate.
Medical necessity
Review available records and, where appropriate, support an appeal with relevant documentation.
Duplicate claims
Review claim history and payer information to determine whether a service was previously submitted or processed.
Coordination of benefits
Identify when other coverage information is needed or another payer should be billed first.
A closer look / 02
Root cause analysis and prevention
We analyze trends across payers, providers, procedures, diagnoses, locations, service types, billing workflows, and authorization processes. Findings can help identify eligibility issues, authorization gaps, documentation concerns, coding problems, filing risks, and payer-specific requirements.
A closer look / 03
Prioritizing denials
Claims are prioritized by outstanding balance, age, payer patterns, timely filing risk, and appeal deadlines so urgent accounts receive attention.
A closer look / 04
Appeals management
Appeal support includes reviewing the reason and requirements, gathering available records, preparing and submitting supporting information, tracking deadlines, following up, and documenting the outcome. The next step depends on payer requirements and the documentation available from your practice.
A closer look / 05
Denial reporting
Reporting provides visibility into outstanding balances and recurring issues.
- Denied claim counts and reasons
- Denial volume by payer
- High-dollar and aging denials
- Appeal activity and resolved denials
- Recurring denial trends
From review to follow-up
A clear process. At every step.
Identify denials
Organize denied claims by reason, payer, age, balance, and other relevant factors.
Review the denial
Review payer responses, claim details, demographics, codes, modifiers, authorizations, provider details, dates of service, and available documentation.
Determine the root cause
Decide whether the denial needs correction, an appeal, additional information, or another action.
Correct the claim
Make supported corrections according to available information and the practice’s workflow.
Submit appeals
Where appropriate, prepare an appeal and supporting records according to payer requirements and track deadlines.
Follow up
Monitor corrected claims, appeals, documentation requests, payments, and further payer requirements through resolution.
Why it matters
Better support for the work behind the care.
- Identify opportunities to recover outstanding revenue
- Reduce research, correction, and payer follow-up work for your staff
- Move delayed revenue through the billing cycle
- Identify recurring issues and improve billing workflows
A little more clarity
Your questions, answered.
Can you handle both corrected claims and appeals?
Yes. Depending on the reason, a denial may require correction and resubmission, an appeal, additional information, or another appropriate resolution.
Do you follow up after submitting an appeal?
Yes. We monitor appeals and corrected claims to determine whether additional action is needed.
Can you identify recurring denial problems?
Yes. Trends can be analyzed by payer, denial reason, service type, and other relevant categories.
Can you work on older denied claims?
Yes. Older claims can be reviewed and prioritized based on balance, aging, payer requirements, and filing or appeal deadlines.
Does every denied claim get appealed?
No. The appropriate action depends on the denial, payer requirements, claim information, available documentation, and applicable deadlines. Some claims need correction or resubmission rather than an appeal.