Denials and appeals
We fight every denial. Even the $58 ones.
Each one is corrected, appealed or called on, then followed to the payer’s decision.
- CO-16Missing infoCorrected, resentPaid
- CO-197No auth on fileAuth found, appealedPaid
- CO-50Medical necessityNotes and policy sentAppealed
- CO-45$58 under contractContract rate shownAppealed
- 277No reply in 30 daysCalled the payerReprocessing
Fighting a denial often pays.
Published data says most appeals win. Few get filed.
-
54%
of private-payer denials were overturned and paid in the end.
Premier survey of 516 hospitals, 2022 claims, published March 2024. Source
-
4 in 5
appealed Medicare Advantage prior-auth denials were overturned, fully or in part.
KFF, 2024 data (80.7%), published January 2026. Source
-
1 in 9
of those denials was appealed at all.
Same KFF analysis, 2024 data (11.5%). Source
These studies cover hospitals and Medicare Advantage, not small practices alone. They describe the industry, not results we promise.
Four ways a denial gets worked.
The reason code picks the path. A person does the work.
-
01
Fix and resend
Wrong member ID, missing detail, another payer is primary. We correct it and send it again.
CO-16 CO-22 CO-31
-
02
Appeal with the records
Medical necessity, authorization, bundling. We write the appeal, attach the notes and the payer’s own policy, and our billing manager signs it.
CO-50 CO-197 CO-97
-
03
Chase the silence
No answer is a denial too. Claims with no reply get a status check, then a call.
276 277
-
04
Check what was paid
A paid claim can still be short. We compare each payment to your contract and dispute the gap.
835 CO-45
Software sorts each denial and tracks its appeal deadline. It never sends or changes a claim on its own.
You see each one, and how it ended.
Every denial sits in your portal with what we did and what came back.
Explore our portal- CLM-20958Cigna · CO-50$212.00Won
- CLM-20961Aetna · CO-16$171.40Paid
- CLM-20977UHC · CO-45$58.00Paid
- CLM-20990Humana · CO-197$96.12Upheld
Denied once
CO-197Visit 13 had no auth number
Checked before every claim since
Auth number required from visit 13
Sample.
Then we stop the next one.
Each denial reason becomes a check before the next claim goes out.
10 common denials and how to stop themWhat owners ask about denials.
Do you really work the small ones?
Yes. A $58 denial gets the same steps as a $5,000 one. Small denials repeat, so the fix pays more than once.
Do appeals cost extra?
No. On claims we send, denials and appeals are part of the same percentage of collections. See pricing.
Will my providers have to write appeal letters?
No. We write them. If a payer needs something only the chart can show, we ask for that one note.
What if the payer was right?
Sometimes it is. Then we say so in your log, fix the cause, and bill the patient only where their plan says they owe it.
What about denials from before we switch?
We review open denials during switching, nearest appeal deadline first. Ones you hand us as old AR are priced only as a share of what we recover. See pricing.
Send us your remits. We’ll show you which denials are still worth fighting.
3.5–5.5% of collections · annual agreement · 45-day opt-out
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