Medical Claim Denial Management & Appeals Services
Identify, correct, and prevent claim denials through analytics-driven tracking, strategic appeals, and root cause analysis.
Proven Results
75% Denial Overturn Rate
60% Reduction in Denials
$450K Average Annual Recovery
<5% Final Denial Rate
Common Challenges
High Denial Rates
15-20% of claims are denied on first submission, requiring extensive rework and creating significant administrative burden on billing staff.
Lack of Denial Tracking
Without systematic tracking mechanisms, denied claims fall through the cracks and go unworked, resulting in permanent revenue loss.
Ineffective Appeals
Generic appeal letters without payer-specific strategies and supporting documentation result in low overturn rates and wasted effort.
Recurring Denials
The same denial reasons keep repeating because root causes are never identified and systemic issues remain unaddressed.
Resource Drain
Staff spends excessive time working denied claims reactively instead of implementing prevention strategies proactively.
Lost Revenue
Up to 65% of denied claims are never reworked due to time constraints, lack of resources, or missing timely filing deadlines.
Our Solutions
Comprehensive Denial Analytics
Advanced tracking and categorization of all denials with detailed root cause identification to understand patterns and systemic issues.
Real-time denial tracking across all payers
Automated categorization by denial reason codes
Root cause analysis to identify systemic issues
Trend reporting to prevent future denials
Strategic Appeal Management
Expert appeal writers use payer-specific strategies and comprehensive documentation to maximize overturn rates and recover revenue.
Professional appeal letter preparation
Payer-specific appeal strategies
Complete supporting documentation review
75% average denial overturn rate
Denial Prevention Programs
Proactive measures to address root causes and prevent denials before they occur through upfront validation and process improvements.
Upfront claim scrubbing and validation
Pre-submission eligibility verification
Coding accuracy reviews
Authorization tracking and management
Automated Denial Workflows
Technology-driven processes ensure every denial is systematically tracked, worked, and resolved within optimal timeframes.
Automated denial work queues by priority
Deadline tracking to prevent write-offs
Workflow automation reduces manual effort
Complete audit trail for all actions
Service Features
Denial Analysis & Reporting
Track, categorize, and analyze all denials to identify trends, opportunities, and areas for improvement.
Denial reason categorization
Payer-specific analysis
Trend identification
Custom reporting dashboards
Appeals & Reconsiderations
Professional appeal letter preparation with comprehensive supporting documentation for maximum overturn success.
Expert appeal writing
Documentation gathering
Payer-specific strategies
Multi-level appeals
Root Cause Resolution
Identify systemic issues causing denials and implement corrective actions to prevent recurrence.
Pattern recognition
Process improvement
Staff training
Workflow optimization
Denial Prevention
Upfront claim scrubbing and validation to prevent denials before submission.
Pre-submission validation
Coding review
Eligibility verification
Authorization tracking
Client Testimonial
Our denial rate was 18% and climbing when we brought in Medtransic. Their team not only helped us overturn 75% of existing denials, recovering $450,000, but they identified the root causes and reduced our denial rate to under 5%. The impact on our cash flow has been dramatic.