Denials are categorized by root cause (CARC/RARC), prioritized by recoverable value, appealed with payer-specific templates, and fed back into front-end prevention.
Detections stream in from every queue. A named specialist picks each one up, decides, and closes it — nothing is auto-submitted.
- CCReviewing
Certified Coder
Reviewing 99215 + 25
- DSIn progress
Denial Specialist
Appeal drafted
- ARResolved
A/R Specialist
Resolved
- ESReviewing
Eligibility Specialist
Verifying 270/271
- PIIn progress
Payment Integrity Analyst
Variance confirmed
- ACResolved
Authorization Coordinator
Approved
Specialists own every step. Automation handles the repetitive work. Nothing waits in a queue nobody is watching.
Categorize
Every denial is mapped from CARC/RARC codes to a root cause — eligibility, authorization, coding, timely filing, medical necessity, duplicate.
Prioritize
Queues are ranked by recoverable value, likelihood of overturn, and days until the appeal or corrected-claim deadline.
Appeal
Payer-specific templates, clinical documentation, and policy citations through levels one to three, tracked to resolution.
Prevent
Root causes are pushed back to registration, eligibility, authorization, and coding so the same denial does not recur.
AI-assisted pattern detection and decision support that works alongside our billing professionals — never instead of them.
Denial-risk scoring before submission reduces the denials you have to fight at all.
Appeal recommendations match denial reasons to the documentation that overturns them.
Payer pattern detection shows which payers deny which codes — and why.
Specialty-aligned specialists who know your payer rules.
If it's not here, an RCM specialist will answer it directly.
We don't guarantee a number. We measure your baseline during the revenue audit, then report the trend by payer and root cause every month so you can see the change.
A structured review of denials, A/R aging, coding, and underpayments — findings are yours to keep, whether or not we work together.
- · Findings you keep, whether or not we work together
- · No patient information requested
- · A named RCM specialist, not a sales queue
Get your free revenue audit
Step 1 of 4