Every denied claim is revenue your practice has already earned but has not been paid for. Many practices never rework a large share of their denials because nobody has the time. Medical Coder's denial management services recover that money and, just as importantly, stop the same denials from happening again.
What Is Denial Management?
Denial management is the process of identifying why claims are denied, correcting and resubmitting or appealing them, and fixing the upstream problems — eligibility, authorization, coding or documentation — that caused them. Done well, it raises collections and lowers the cost of every claim you submit.
Our Denial Management Process
1. Capture and categorize every denial
We read each remittance and group denials by CARC/RARC reason code, payer, provider and procedure, so patterns become visible instead of hiding in individual EOBs.
2. Work and appeal
Correctable claims are fixed and resubmitted quickly. Claims that were denied incorrectly get a written appeal with the supporting documentation, filed inside the payer's appeal deadline.
3. Find the root cause
For every recurring denial we trace the cause back to the front desk, the coding step or the payer rule — and fix it at the source.
4. Prevent and report
We update claim-scrubbing rules and front-desk checklists, then report monthly on denial rate, dollars recovered and the top reasons, so you can see the trend.
Common Denials We Fix
- CO-16 – Missing information — typical cause: Incomplete claim or patient data. How we prevent it: Claim scrubbing before submission.
- CO-197 – Authorization absent — typical cause: Prior authorization not obtained. How we prevent it: Authorization checks before the visit.
- CO-29 – Timely filing expired — typical cause: Claim submitted or corrected too late. How we prevent it: Filing-deadline tracking by payer.
- CO-50 – Not medically necessary — typical cause: Diagnosis does not support the service. How we prevent it: Coding and documentation review.
- CO-97 – Bundled service — typical cause: Procedure included in another code. How we prevent it: NCCI edits and correct modifier use.
- Eligibility / coverage terminated — typical cause: Insurance not verified. How we prevent it: Real-time eligibility verification.
Denial Management for Texas Practices
Texas practices face payer-specific denial patterns — Texas Medicaid's tight 95-day filing window through TMHP, authorization rules from STAR and STAR+PLUS managed care plans, and Novitas Medicare edits. We know these rules and build them into our workflow. See our Texas medical billing services and our San Antonio team.
Denial Management as a Standalone Service — or Full Billing
You can keep your in-house billing team and hand us only denials and aged A/R, or let us run your complete medical billing. Either way, you pay based on what we recover.
Start With a Free Denial Audit
Send us a sample of your recent denials and we will show you how much is recoverable and what is causing them. Also see our full medical billing audit services. Request your free denial audit.