denial management services
Denial management that names the reason
A denial is a reason code, not a mood. MedFlow reads the code, routes the claim, and works the ones that can still be paid.
How a denial is routed
Payers send claim adjustment reason codes. Some mean the claim was missing a modifier or a diagnosis link, and billing can fix and resubmit. Some mean the clinic has to supply a referral or a new insurance card. Some are appeals, when the note supports medical necessity and the payer said it did not. Some are the patient’s balance, when the service is not covered and the patient was told.
We do not appeal a timely-filing denial unless there is proof the claim went out on time. We do not resubmit an exact duplicate.
What small practices usually lose
The first loss is silence. A denied claim sits because nobody owns the worklist. The second loss is a corrected claim that repeats the same mistake. The third is an appeal letter that does not quote the note.
Our target is a denial rate under 8% of adjudicated claims. That is a MedFlow target, the same one on the product dashboard, not a national percentile. The health check uses your own denial rate against that target.
Included
- Posting of the denial from the electronic remittance
- A worklist sorted by what has to happen next
- Corrected claims when the fix is in the codes or modifiers
- Appeals when the record supports them
- A monthly count of denials by reason
See what your billing is leaving behind
Share monthly totals. We will tell you where the gaps are. No patient information.