Clinical denials and appeals are often intertwined with clinical authorizations, Clinical Documentation Integrity (CDI), and Utilization Review (UR) processes. Our comprehensive services help healthcare organizations effectively manage and resolve denials to protect revenue and streamline operations.

Our clinical denials and appeals services include:

• Thorough review and analysis of denials, focusing on medical necessity, MS-DRG/APR-DRG downgrades, length of stay, level of care, and managing subsequent appeals to overturn clinically based denials

• Collaboration with physicians and hospital departments to clarify documentation and provide supporting clinical evidence to defend claims

• Preparation of professional, well-substantiated appeal letters tailored to payer requirements

• Regular reporting and education on denial trends, root causes, and key findings to inform continuous improvement

• Timely submission of clinical appeals to prevent revenue leakage and reduce delays in payment

• Simplification of Revenue Cycle Management (RCM) workflows by integrating denials management into broader clinical and administrative processes

By addressing clinical denials proactively and comprehensively, we help you maximize reimbursements and maintain financial health.