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Denials investigated and appealed, not written off

A denial isn't the end of a claim — it's a step that requires a specific response. We identify the root cause and appeal with the documentation each payer requires.

Denial Management

Recovering revenue that's already been earned

Every denial has a cause, and most causes are correctable — a missing modifier, an eligibility mismatch, insufficient documentation, or a payer-specific requirement that wasn't met. Writing off a denial without investigating it means writing off revenue you already earned.

Claimora categorizes every denial by reason code, corrects what's fixable, and files appeals with the specific documentation each payer requires — while tracking denial trends so the same issue doesn't keep recurring.

What's Included

What our denial management covers

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Denial categorization by reason code and root cause
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Claim correction and resubmission for correctable denials
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Formal appeals with payer-specific documentation requirements
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Peer-to-peer review coordination for clinical denials, where applicable
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Timely appeal filing to meet payer-specific deadlines
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Denial trend reporting to identify and fix recurring issues at the source
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Coordination with coding and eligibility teams to prevent repeat denials

RCM Services

Medical Billing Services Credentialing & Enrollment Eligibility & Benefits Verification Medical Coding Claims Management Payment Posting Accounts Receivable Denial Management & Appeals

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Our Process

From denial to resolution

Denial Intake & Categorization

Every denial is logged and categorized by payer, reason code, and root cause.

Root-Cause Investigation

We determine whether the denial is correctable — a coding error, missing documentation, or eligibility issue — or requires a formal appeal.

Correction or Appeal

Correctable claims are fixed and resubmitted; others are appealed with the specific documentation the payer requires.

Deadline Tracking

Appeal deadlines are tracked closely, since most payers allow only a limited window to appeal.

Trend Reporting

Denial patterns are reported back so recurring causes — a specific code, a specific payer — can be addressed upstream.

Common Questions

Frequently asked questions

We handle both technical denials (eligibility, coding, authorization) and clinical denials that may require peer-to-peer review or medical necessity documentation.

We weigh the likelihood of a successful appeal against the claim value and payer deadline, and keep you informed on anything borderline.

Yes — denial trend reporting is part of the service specifically so recurring, preventable causes get fixed at the source rather than appealed repeatedly.