Denial Management
Denials aren't an ending — they're a starting point. We work every denial within 24 hours, file structured appeals, root-cause the trend, and rewire your front-end so the same denial doesn't happen again next month.
85%
Appeal overturn rate
On clinical and technical denials
50%
Drop in overall denial volume
Within 6 months of onboarding
< 7 days
Average appeal turnaround
From denial receipt to appeal sent
A disciplined approach to denial management
Denial management is two jobs in one — and most billing teams only do half. They work the denials in front of them but never fix the upstream process that keeps creating them. That's why their denial rate never drops.
We do both. Every denial is worked within 24 hours with a structured appeal where appropriate. At the same time, every denial is tagged by root cause (eligibility, auth, coding, documentation, payer policy) and rolled into a monthly trend report — with concrete recommendations to fix the front-end so the same denial doesn't recur.
What makes our denial management different
Six advantages your team feels in the first 30 days.
24-hour denial pickup
Every ERA / 835 is reviewed daily — no denial sits longer than one business day.
Structured appeal packets
Pre-built appeal templates by payer and denial reason, with the right clinical attachments.
Root-cause tagging
Every denial coded back to its origin: eligibility, auth, coding, charting, payer policy, timely filing.
Monthly trend report
What denied, why, by which payer — and which 3 changes will eliminate the most volume.
Front-end fixes, not just back-end appeals
We close the loop with your scheduling, eligibility, and coding teams to prevent repeats.
Timely-filing safety net
Daily aging review on denials keeps appeal deadlines from quietly expiring.
Everything inside the Denial Management engagement
One flat scope. No surprises. No nickel-and-diming for the work that actually moves revenue.
Backed by our service guarantee
If our work doesn't move the metric in 90 days, we don't charge for the next month. Simple.
- Daily ERA / 835 review and denial intake
- Denial categorization by CARC / RARC code and root cause
- Same-day correction and refile for technical denials
- Structured first-level appeals with clinical documentation
- Second-level appeals and external review when warranted
- Peer-to-peer coordination for medical necessity denials
- Root-cause feedback to eligibility, auth, coding, and provider teams
- Monthly denial trend report with prioritized fix recommendations
- Timely-filing deadline tracking and alerts
Our process, end-to-end
Five repeatable steps. No black-box. You see every handoff.
Capture
Every ERA is reviewed daily. Denials are pulled into a worklist within 24 hours.
Diagnose
Each denial is coded to a root cause: eligibility, auth, coding, documentation, payer policy.
Resolve
Correctable denials are refiled same-day. Clinical denials get a structured appeal packet.
Recover
Appeals are tracked daily; peer-to-peer scheduled where needed; outcome posted.
Prevent
Monthly trend report feeds upstream teams so the same denials don't repeat.
Denials we resolve
From the most common technical edits to complex medical-necessity disputes, we work the full spectrum — across every major commercial and government payer in the US.
9 denial categories we work daily
Payer scope — government & commercial
“We always worked denials. What changed with TrueClaim is the trend report. They didn't just appeal — they showed us the three changes that cut our denial rate in half.”
Anna F.
Billing Manager · Specialty practice group, NY
HIPAA
Compliant workflow with BAA
US-Based
Operations and oversight
Encrypted
End-to-end data handling
Audit Trail
Every action logged
Everything you wanted to ask about Denial Management
Can't find what you need? Ask a specialist.
Pair this service with
AR Recovery
Aging A/R is unpaid work. Our recovery specialists chase down 30+, 60+, and 90+ day claims with aggressive payer follow-up, structured appeals, and weekly cash-flow reporting — until your money is in the bank.
Learn more →
Medical Billing & Coding
AAPC- and AHIMA-certified coders, end-to-end claim submission, and a quality program built to push your first-pass clean-claim rate above 99% — so revenue lands in days, not weeks.
Learn more →
Eligibility Verification
Eligibility is the #1 reason claims get denied. We verify every patient before they walk in — active coverage, deductible, co-insurance, and benefit limits — so front desk knows what to collect and billing knows the claim will pay.
Learn more →
See what denial management
should be doing for you.
30 minutes with a specialist. We'll review your current performance, surface the top three opportunities, and tell you exactly what we'd change. No sales pitch.