Our approach
- Analyze denial and remittance data by payer, reason code, provider and service
- Separate coding and documentation causes from eligibility, authorization and timely-filing causes
- Recommend fixes at the point where each error starts
- Build simple checklists and edits to catch errors before submission
Common denial causes we address
- Missing or invalid modifiers and NCCI conflicts
- Diagnosis codes that don't support medical necessity
- Missing prior authorization or referral
- Eligibility and coordination-of-benefits errors
- Late submission past the payer's filing limit
Payer-specific rules
We account for each payer's rules when reviewing denial trends, across Medicare, state Medicaid programs, Medicare Advantage and commercial plans. Always confirm current requirements in each payer's provider manual.
Frequently Asked Questions
What data do you need?
Denial and remittance reports (835 data or a denial export from your billing system) for the last several months are usually enough to identify the main patterns.
Do you appeal denied claims?
Our focus is prevention and root-cause correction. We can advise on documentation to support appeals.