We get paid only when we recover your denials

No risk to you. We analyze your denials and categorize which ones can be recovered. We go ahead and recover those monies for you. We collect 5% of those recovered amounts. That’s about all there’s to it. We both get paid.

Some examples of our work

56%

DENIALS RECOVERED IN 1ST QUARTER ITSELF

50%

REDUCTION IN 1ST PASS DENIAL RATE IN 1ST QUARTER ITSELF.

50%+

REDUCTION IN CREDENTIALING RELATED DENIALS

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HOW MUCH DO YOU WANT TO GROW?


Top denials reasons

  • Credentialing Issues
  • Eligibility issues
  • Prior authorization issues
  • Inadequate documentation
  • Missing referrals
  • Under or upcoding issues
  • Demographics issues
  • Payer issues

Denials buckets – understand and use them

  • Provider is considered out of network.
  • No prior authorization or precertification.
  • Incomplete claim information entered.
  • Medical necessity – not sufficiently supported documentation provided.
  • Lower level CPT was deemed appropriate but your provider did a higher level, more costly service
  • Procedure or CPT is not covered in a patient’s benefits.
  • Ineligible patient – i.e. patient no longer covered
  • Pre-existing conditions – not covered by the policy.
  • CPT and ICD mapping/linking issue.
  • Bundled service was unbundled

Our simple, effective reporting

Opening Balance$1,000,000.00   
Closing Balance$500,000.00   
Recovered$500,000.0050%  
Categories BreakdownOriginal $Original %Recovered $Recovered %
Coverage$300,000.0030.00%$100,000.0033.33%
Authorization$200,000.0020.00%$100,000.0050.00%
Coding$300,000.0030.00%$100,000.0033.33%
Enrollment$100,000.0010.00%$100,000.00100.00%
Justification$100,000.0010.00%$100,000.00100.00%
 $1,000,000.00100.00%$500,000.0050.00%
Check$0.00 $0.00 

What’s denials costing you?

  • Industry avg is 5 – 10 %
  • 2 provider practice avg – 80 denials a month ..
  • Potential Loss = $8k/mo.
  • $25 / claim reworked.
  • End of month, practice spent $ 3k to recover approximately $7k (of 8K).
  • Actual Loss = $4K.

How we work for you

  • We will recover your denials
  • We will identify upstream issues and advise you
  • Our call center and practice management staff can handle scheduling, credentialing, eligibility, prior authorizations, patient intake for you OR simply advise and monitor your staff.

Contact Sales

If your team is doing better than this, you don’t need our help. Otherwise, reach out to our team and we will get started within 2-3 weeks based on our current workload.

    • Once you click on submit, we will email you our business associate agreement. This ensures that your patient data (PHI) is protected and has our guarantee. Please sign and email us back the BAA with your denials file (we accept only CSV or spreadsheets format files).
    • Based on our workload, we can typically get started in 2-3 weeks time. We look forward to working with you.