Denial Management Services
Get Paid for Denied Medical Coding Claims and Patient Bills
Reacting to claim denials is one thing, but what if you could prevent many of them in the first place? That’s the core of our approach. EdgeRCM provides truly effective DENIAL MANAGEMENT SERVICES centered around strong denial prevention tactics.
Many physicians and hospitals outsource their denial management to EdgeRCM. Our denial management services go beyond standard medical billing by employing coding experts and appeal specialists focused solely on overcoming denials.
We look at why your claims get denied – maybe its medical coding habits or authorization workflow – and help fix the root cause. Get full-service Denial Management & Appeals Service you can trust.
- Experts turn denied claims into recovered cash for you.
- Handling technical slips, authorization issues, and coding denials.
- Helping recover payments that might otherwise slip away.
- Smart denial management software to speed things up.
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Stats of our Claim Denial Management Services
Almost 99%
Clean
claim ratio
About 97.35%
1st submission pass rate
Up to 30%
Revenue Increase
Outsource To Top-Rated Healthcare Coding Denial Resolution Service in the USA
We believe in showing results. While we track lots of details behind the scenes, here are a few key things we focus on to make sure our denial management is making a real difference for you:
- All Payers Supported
- Less Written Off
- Impossible Denial Flips
- Guaranteed Appeal Wins
- Minimum Denial Resolution Time
- Support with Denied Aging Claims
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99%
Based on a 4.8-star rating from 350+ providers across the states.
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2.00x
CMRS, RHIA, CPB certified medical billers and coders for every specialty.
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About Us
Choosing EdgeRCM Denial Management Services
Trying to manage submissions, denials, understanding claim resubmission guidelines, and maybe handling first-level appeal submissions takes time away from your patients. You shouldn’t have to wrestle with setting up denial workflow automation or solving tricky payer contract compliance rules.
That’s where our medical coding denial management service fits in. We really dig into denial management analytics and figure out the ‘why’ behind denials (denial root cause analysis) to help stop them before they start. Our job is to build smart claim denial prevention strategies for all medical specialties, clinics, and hospitals. We handle the tough stuff with denials & work to boost your first-pass resolution rate.
Benefits Of Our Healthcare Denial Management Service
Faster Payments
Speed up how quickly you receive money for patient services.
Fewer Rejections
Reduce the number of claims getting denied by payers.
Income Boost
Recover revenue that might otherwise be lost to denials.
Steady Flow
Create more predictable income coming into your practice.
Time Back
Free up your team's time previously spent chasing denials.
Reduced Hassle
Lessen the daily headaches caused by claim payment issues.
Clearer Trends
Gain insights into why your specific claims get denied.
Keep Up
Help manage tricky payer rules and important filing deadlines.
Better Reports
Get easy-to-understand data on denial trend and appeal success.
They Said No? We’ll Make It a Yes.
Insurance companies love saying no. We love making them change their minds. Even the claims you gave up on, we’ll revive them and put money back in your pocket.
How Do We Help You?
EdgRCM Provides End-to-End Denial Management Solutions
Feeling like denied claims are always putting the brakes on things? You’re busy caring for patients, but then these claim denials pop up, creating a real headache in your revenue cycle. It’s honestly tiring, and you see it hitting your cash flow and Days in Accounts Receivable (DAR).
Getting to the bottom of why they happen – that denial root cause analysis – is how EdgeRCM’s denial management experts start building good claim denial prevention strategies. Let’s look at some common reasons claims get stuck, keeping an eye on payer-specific denial trends.
⬇️ Do any of these feel familiar? ⬇️
Small Slip-Ups in Patient Info?
Isn’t it maddening how tiny mistakes, like a wrong birth date or a patient’s name misspelled, lead right to a denial? These eligibility verification errors seem small but cause big hold ups in getting paid.
The solution:
Aiming for clean claims submission every time. Our denial management service catches those little errors before the claim goes out. Thanks to our advanced denial prevention tools that check medical coding information right away and prevent lots of common denials.
Getting Medical Necessity Denials from Coding Issues?
Payers check ICD-10 codes, CPT codes, and HCPCS code accuracy very carefully. Just one wrong code, maybe flagged as modifier misuse, can cause a coding denial. Keeping up with payer reimbursement policies on codes takes effort.
The solution:
Doing regular coding accuracy audits is our solid approach to manage healthcare coding denials. Making sure ICD-9 and ICD-10 codes match the care given and what payers expect cuts down on these annoying claim rejections and helps avoid flags for things like upcoding/downcoding.
Running Into Timely Filing Limit Compliance Problems?
Those claim submission deadlines feel like strict cut-offs. Send a claim past the payer’s timely filing date, and they often just won’t pay. That’s lost money just because time ran out, hurting your denial rate benchmarking.
The solution:
A good way to handle denial tracking and reporting for deadlines helps a lot. EdgeRCM sets up systems to track those dates, keeping your AR (Accounts Receivable) recovery teams on track and preventing write-offs from late claims.
Sending Duplicate Billing by Mistake?
Ever had a claim denied because it looked like you sent it twice? Duplicate billing, even by accident, usually gets a quick denial. It just confuses things and delays payment for the real service.
The solution:
Good claim scrubbing before sending catches those duplicate billing issues. Our denial prevention teams double-check that each claim is accurate, preventing these easy-to-avoid denials.
Stuck with Prior Authorization Denials?
You know those services needing that pre-authorization verification green light from insurance before you do them? Missing that step often means a fast prior authorization denial. It’s a frequent spot for revenue leakage.
The solution:
Having a clear process or authorization tracking system makes sure you get that OK beforehand. This avoids those frustrating claim rejections and smooths out the financial clearance process.
Dealing with Coordination of Benefits (COB) Errors?
When patients have more than one insurance plan, figuring out who pays first can be tricky. Simple Coordination of Benefits (COB) errors cause denials and mean extra follow-up work, sometimes leaving patients with unexpected bills (patient responsibility denials).
The solution:
Using tools for benefits verification early on helps get claims to the right payer first, reducing delays caused by COB mix-ups.
Who Do We Serve?
No matter who needs denial management services, we can serve various groups.
Hospitals and Healthcare Facilities
Independent Practices & Multi-Specialty Groups
Ambulatory Surgery Centers
Diagnostic and Imaging Centers
Skilled Nursing Facilities (SNFs)
Physical Therapy and Rehabilitation Clinics
Behavioral Health Clinics
Urgent Care Centers
Plastic Surgery Clinics
Revenue Leakage Prevention
How EdgeRCM Denial Management Services Help Optimize Revenue Cycle?
It’s incredibly frustrating when the payment for care you delivered gets blocked by a medical necessity denial or tangled up in constantly changing payer policy updates, isn’t it? That endless cycle of ‘Fix-and-Resubmit’ drains valuable time and hits your revenue hard. We really get that grind.
EdgeRCM provides specialized denial management services, acting as your partner to sort through these denials and improve your billing outcomes. Our End-to-End Denial Management Solutions aim for a higher clean claims submission rate because we are serious about coding accuracy audits and know the ins and outs of effective denial appeal services.
Here's how our Claim Denial Management Services help practices like yours:
Focusing on Correct Codes (Coding Denial Management)
Medical necessity denials and issues with CPT code mismatches are huge reasons for claim pushback. Strong ICD-10 coding compliance is essential. Our Coding Denial Management Services concentrate on getting these details right to meet payer reimbursement policies.
- Ensure HCPCS code accuracy.
- Address modifier misuse correction.
- Support DRG validation processes.
- Reduce coding-related denials.
Stopping Denials Proactively (Denial Prevention Strategy)
Effective Denial Prevention Services are key to a healthier revenue cycle. This involves thorough Denial Identification and Analysis. We look closely for patterns, like missing documentation requests or common eligibility verification errors, and tackle the denial root cause analysis head-on.
- Identify payer-specific denial trends.
- Flag missing pre-authorization verification.
- Implement claim denial prevention strategies.
- Aim to lower your overall denial rate.
- Utilize claim scrubbing software benefits.
Getting Your Earned Money Back (Revenue Recovery & Appeals)
A denial isn’t the final word. Our Denial Recovery Services focus on underpayment recovery services and managing the appeals process. This includes crafting payer reconsideration letters and pursuing 1st level appeal submissions because we aim for a better denial reversal success rate.
- Manage claim resubmission guidelines.
- Handle denial escalation protocols if needed.
- Use retrospective claim reviews to find opportunities.
- Turn denied claims into recovered revenue.
Tackling Old Balances (RCM Denial Management Services for AR)
Unpaid claims piling up impact your Days in Accounts Receivable (DAR). Our AR (Accounts Receivable) recovery teams provide focused RCM Denial Management Services. We work on the oldest unpaid claims, keep contacting patient’s insurance companies (your payers), and watch the progress closely with tracking tools, while closing off routes where expected medical revenue disappears.
- Address aged claims proactively.
- Handle payment follow-up consistently.
- Provide clear denial tracking insights.
- Work on write-off reduction strategies.
- Help resolve self-pay denial issues.
Tailored Help for Different Settings (Hospital & Physician Denial Management)
We know Hospital Denial Management differs from Physician Practice Denial Management. Whether it’s in-patient complexities, outpatient denial management, or Specialty Clinic Denial Management, our approach adapts. We work within HIPAA-Compliant Denial Management standards for all settings.
- Understand Medicare / Medicaid denial patterns.
- Navigate commercial payer denial trends.
- Address setting-specific challenges, like outpatient surgery coding denials.
- Aims to maximize reimburesment across the board.
Focusing on Correct Codes (Coding Denial Management)
Medical necessity denials and issues with CPT code mismatches are huge reasons for claim pushback. Strong ICD-10 coding compliance is essential. Our Coding Denial Management Services concentrate on getting these details right to meet payer reimbursement policies.
- Conduct thorough claim audits for accuracy.
- Implement denial workflow automation where helpful.
- Use predictive analytics for denials insights.
- Aim for Denial Management for Revenue Cycle Optimization.
- Improve your 1st attempt claim submission approval rate.
Service Offerings
Our Denial Management Services Include
Denial Analysis
Digging into denial reasons and patterns.
Appeals Management
Handling the full appeal process for denied claims.
Coding Audits
Reviewing CPT, ICD-10, and HCPCS codes linked to denials.
Root Cause ID
Pinpointing the exact origin of claim denials.
Trend Tracking
Monitoring denial patterns by payer, department, or service line.
Prevention Strategy
Developing steps to stop common denials recurring.
Payer Follow-up
Actively contacting payers on submitted appeals status.
Authorization Support
Helping track and verify necessary patient pre-approvals.
AR Recovery
Focusing effort on aged, denied claims sitting in receivables.
Compilnce Checks
Making sure appeals follow payer and regulatory guidelines.
Performance Reports
Providing clear data on denial rates and recovery success.
Clinical Review
Assisting with medical necessity documentation gathering.
Why Outsource To Us?
Guaranteed Payment Recovery with EdgeRCM Denial Management Outsourcing Solutions
Getting a submitted claim pushed back because of a coding mistake feels like a major setback and requires focused denial management expertise. A wrong ICD-10 diagnosis code that doesn’t properly support the billed CPT procedure code leads to medical necessity denials. OR maybe just a simple CPT code mismatch can halt payments on that specific claim.
We know these coding specifics really affect your daily workflow and directly hit your healthcare specialty’s income, making coding denial management services essential. EdgeRCM denial management experts are centered on getting your coding accurate before each claim is sent out.
Instead of just reacting to denied claims and managing endless claim resubmissions, the EdgeRCM Denial Management Service aims to help you submit cleaner patient claims consistently. Here’s how our denial management experts assist:
Smart claim scrubbing techniques:
Paper claims? Filing cabinets overflowing? Come on, it’s 2025! With EHR-integrated billing, say hello to automated claim submissions. We’re talking quick, accurate electronic claims zipping off to insurance companies at the speed of, well, the internet. Plus, you can automate appointment scheduling within your EHR.
We double-check the codes match the patient visit:
Imagine knowing instantly if a patient’s insurance is active before their appointment. Sounds nice, right? Real-time eligibility verification, powered by EdgeRCM’s smart cardiology EHR billing software, makes that a reality. It’s like a quick insurance health check-up for each patient, right when you need it. This catches coverage issues upfront, reducing denials before they even happen. You get paid for the care you provide, and patients aren’t hit with surprise bills.
Getting modifiers right really counts:
Manually tracking payments and typing them into your system… sounds like fun? Probably not. Prompt payment posting automates this in our system. We track payments from insurance and patients super efficiently and update your financial records in your EHR.
Avoiding risky coding moves:
Manually tracking payments and typing them into your system… sounds like fun? Probably not. Prompt payment posting automates this in our system. We track payments from insurance and patients super efficiently and update your financial records in your EHR.
Let’s Make Denials One Less Problem.
It’s easy to feel like you have no voice against insurance denials. We make sure you do… LOUD & CLEAR!
Our Denial Management Service Workflow
A solid denial management process is key to reducing lost income and keeping payments flowing for your medical specialty. When nearly 1 in 5 submitted claims face rejection, and many of those never get resubmitted, it causes real financial strain.
EdgeRCM’s medical coding denial resolution service aims for prompt payment with a less than 2% denial ratio (means you have a guaranteed peace of mind that you are getting reimbursed for atleast 98% of insurance billing claims every day).
Here’s how we approach things:
Patient Registration
Our Denial Management Coordinators use claim tracking systems and review remittance advice (ERAs/EOBs) carefully. This allows them to quickly flag any denied claims, kicking off the resolution steps without delay.
Medical Coding
Our Revenue Integrity Analysts dig deep to perform a thorough denial root cause analysis. They closely examine the denial codes, CARC/RARC messages, and specific requirements from payers to understand exactly why the claim was denied.
Claims Submission
For denied claims needing an appeal, the process involves careful preparation. Input from Clinical Denial Managers (for medical justification) and Medical Coding Compliance Officers (for coding corrections) ensures the appeal is strong and aligns with compliance rules, boosting the chance of approval.
Payment Posting
Our dedicated Denial Management Coordinators and AR Recovery Teams keep close tabs on appealed claims. We use real-time claim tracking to follow up with payers, get updates on decisions, and provide any extra information needed promptly.
Prior Authorization &Eligibility Verification
Our dedicated Denial Management Coordinators and AR Recovery Teams keep close tabs on appealed claims. We use real-time claim tracking to follow up with payers, get updates on decisions, and provide any extra information needed promptly.
Charge Entry
Our Denial Management Coordinators use claim tracking systems and review remittance advice (ERAs/EOBs) carefully. This allows them to quickly flag any denied claims, kicking off the resolution steps without delay.
Denial Management
Our Revenue Integrity Analysts dig deep to perform a thorough denial root cause analysis. They closely examine the denial codes, CARC/RARC messages, and specific requirements from payers to understand exactly why the claim was denied.
Medical Billing Audit
Our Revenue Integrity Analysts dig deep to perform a thorough denial root cause analysis. They closely examine the denial codes, CARC/RARC messages, and specific requirements from payers to understand exactly why the claim was denied.
Denial Analytics Tools
EdgeRCM CodeInsight™ Denial Management Software
That moment a claim bounces back for a coding reason? Like a wrong ICD-10 or a misused modifier? For any healthcare specialty trying to get fairly paid for their work, medical coding denials are a persistent challenge.
This is exactly why we developed EdgeRCM CodeInsight™ Denial Software. This specialized denial management software is built specifically to catch potential medical coding errors before they result in a rejected claim. It’s an automated denial management tool focused purely on coding accuracy.
- Checks ICD-10 to CPT/HCPCS links for medical necessity support.
- Applies automated checks for correct modifier usage against payer rules.
- Incorporates known NCCI edits and common commercial payer specific denial logic
- Allows setup of unique edits based on your frequent coding denials or contracts.
- Provides simple, actionable flags highlighting specific potential coding errors.
- Helps prevent inadvertent upcoding/downcoding, supporting audit readiness.
- Designed to fit smoothly within your existing EHR-integrated denial workflows.
Getting this Denial Management Software
The EdgeRCM CodeInsight™ Denial Software is available as a standalone denial management solution. It has an easy integration and hooks directly into your existing medical billing workflow + connects smoothly with your EHR software.
Alternatively, if you choose EdgeRCM for your full medical billing and coding services (our rates start low, at just 2.49% of monthly collections), this powerful Denial Management Software is included for you at no additional software cost. So it becomes part of the comprehensive RCM denial management services we provide.
How This Denial Management Solution Stops Coding Denials?
Now, this isn’t just a generic denial analytics tool. The EdgeRCM CodeInsight™ Denial Software is fully customizable. We take the time to tailor its rules engine specifically for your needs. That means configuring it for your medical specialty’s common codes, the specific payer edits you encounter most often, and even the distinct state protocols for where your practice is located.
Claim Entered:
As soon as claim data hits your system, the EdgeRCM CodeInsight™ Denial Software immediately starts its denial audit services on the coding components.
Software Checks:
The denial management software runs instant checks. It compares diagnosis codes against procedure codes (ICD-10 vs CPT/HCPCS validation), flags potentially incorrect modifier applications based on its built-in logic, and identifies patterns known to cause payer rejections. Its denial reason code mapping logic helps anticipate issues.
Pre-Clearinghouse Scrub:
Before even reaching the clearinghouse, this software has already performed a deep coding review, acting as an automated layer of claim scrubbing specific to coding rules.
Cleaner Submission:
Because the Denial Management Software flags potential coding problems for review before transmission, the likelihood of claims getting denied for these reasons drops significantly. This denial management system helps ensure coding accuracy against thousands of established rules and payer preferences.
Behind Every Denial is a Flaw We Can Fix!
The first denied claim you recover with us will change how you think about your business forever. Hope isn’t a revenue strategy. We build the system behind your practice that makes denials rare and recoveries routine.
Underpayment Recovery
Our Hospital Denial Management Services Converting Denied Claims into Approved Payments
Reports show that nearly 1 in 10 hospital claims gets denied these days, and that puts a real squeeze on the revenue needed to keep all departments operational. We see that pressure across the healthcare industry and EdgeRCM is focused on helping turn those numbers around, specifically offering Hospital Denial Management services.
We’re comfortable working within the complex billing structures of large healthcare systems, aiming to recover denied revenue tied up in rejected hospital claims. Our dedicated denial management team understands the hospital setting. We work closely with your various hospital billing departments – perhaps reviewing intricate claims coming from radiology, high cost surgical procedures, long inpatient stays, or high volume emergency department encounters.
And think about missing patient insurance pre-approvals for scheduled surgeries or advanced imaging. That causes so many payment hold ups in a busy hospital environment, right? So we help implement systems or checks for needed prior authorization verification before the service happens, stopping those difficult denials proactively.
Physicians Love Our 5-Star Denial Management Support
Dr. S Petrova
OB/GYN
Billing for births and related care always had weird denial issues. EdgeRCM knows these specific problems and helps us get our full payments for maternity services.
Dr. B Gupta
Physical Therapist
We lost money on sessions that got denied because of policy stuff or minor errors. BMDX denial management service quickly finds these and gets them fixed and paid, recovering our lost income.
Dr. E Harrison
Orthopedic Surgery
Getting approval for surgeries is hard, but even after that, claims got denied. Your team jumps on these denials fast and helps us collect the money we earned for operations.
The frustration of claims coming back unpaid leaves money hanging. We see it and frankly, it’s why our Denial Management Services Company in the USA exists. Our CPC, CCS & CPB certified billers and coders are experts at talking to insurance companies to push denied payments through.
And honestly it doesn’t matter where your practice is dealing with these claim troubles. If you’re facing denial fights in New Jersey, or getting claim delays in sunny Florida, working hard in California, or anywhere across the entire USA, maybe Texas or New York, we help.
Just schedule a simple, free chat. We can talk about your situation. Or call us direct for that kind of fast support at +1 888 987 6250. Seriously lets just talk and get this stuff sorted.
