Free A/R review

Service

Denial management and appeals

A denied claim is not lost money, it is unworked money. The difference between a billing service that reduces your denial rate and one that just reports it is whether anybody fixes the cause upstream.

Worked by reason code, not by age

Every denial is triaged by its claim adjustment reason code and any accompanying remark code, because the code determines the remedy. A CO-97 bundling denial needs a modifier review; a CO-16 needs the missing element identified and the claim corrected; a CO-29 needs proof of timely filing rather than an appeal on the merits. Sorting a denial queue by dollar value or age without reading the codes is how practices end up re-denying the same claims.

Corrected claim or appeal

Not every denial is an appeal. Many are resolved faster with a corrected claim, and filing a formal appeal where a correction would do wastes the appeal window. Where an appeal is genuinely required, it goes out with the payer policy language and the documentation that addresses the stated reason, not a generic letter.

Fixing the cause upstream

A denial trend that repeats is a process defect, not bad luck. Recurring codes get traced back to the point they originate — registration, documentation, coding, or an authorization step that is being skipped — and the fix goes there. You see which codes are trending monthly, with the volume and dollars attached to each.

What is included

  • CARC and RARC triage
  • Corrected claims and appeals
  • Payer policy documentation
  • Monthly denial trend report
Denial management and appeals — referencelast verified 2026-08-15
Reason code standardCARC and RARC codes maintained by X12source: X12, Claim Adjustment Reason Codes
Medicare appeal levelsFive levels, beginning with redeterminationsource: CMS, Fee-for-Service appeals

Common questions

Do you work old denials or only new ones?
Both, though old denials are scoped separately because some are past appeal deadlines and are not recoverable. We tell you which is which before starting rather than billing you to chase claims that cannot be paid.
What is the difference between a rejection and a denial?
A rejection was stopped before the payer adjudicated it, usually at the clearinghouse, and can simply be corrected and resent. A denial was adjudicated and refused, and needs either a corrected claim or an appeal depending on the reason code.
Will our denial rate actually go down?
That depends on what is causing your denials. If they are coding and documentation issues we can fix them; if they are front-desk registration errors, the fix involves your staff and we will tell you so. We would rather set that expectation than promise a number.

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Next step

Start with the free A/R review.

Send an aging summary and a handful of denials. You get a written read on what is recoverable — no fee, no obligation to sign anything.

Book the A/R reviewSee pricing