Recover what was wrongly refused

Denial Management & Appeals

Q: Do you only chase the large denials?

No. Small denials are where practices bleed quietly, because each one is individually not worth a staff member’s afternoon. We work the full queue and use volume patterns to fix causes.

Q: How fast do appeals need to be filed?

Payer appeal windows commonly run 60 to 180 days from the remittance date, and some are far shorter. We file within seven days of the denial posting to keep every option open.

Every denial is worked, categorised and appealed with payer-specific documentation — and the root cause is fixed so it does not repeat.

Two Billmax MD specialists reviewing a denied claim before drafting the appeal

100%, not just high-dollar
Denials worked: Within 7 days
Appeal filing: Monthly reporting
Root-cause loop

What this actually involves

Roughly two thirds of denied claims are recoverable, yet most practices never resubmit them. We work every denial rather than triaging by dollar value, categorise it by CARC/RARC reason, and build appeals with the clinical documentation and payer policy citations that actually overturn decisions. Just as importantly, denial reasons are traced back upstream so the same error stops being generated.

How we run it

1
Categorise
Each denial is coded by reason so patterns, not just incidents, become visible.
2
Decide the route
Some denials need a corrected claim; others need a documented appeal. They are not the same.
3
Appeal with evidence
Appeals cite the clinical note and the payer’s own published policy.
4
Close the loop
The upstream cause is reported back so the denial stops being created.

Questions