We don't just track denials; we resolve them. Turn your rejected claims into realized revenue with aggressive multi-level appeals.
Every year, billions of dollars are lost due to unresolved denials. Most medical practices lack the time and expertise to follow up on complex Level II and Level III appeals, leading to massive write-offs. Insurance companies count on this—they know most denials won't be appealed. Your money sits uncollected while your staff struggles with administrative burden.
OrbixRCM performs a comprehensive root-cause analysis on every denial. We correct the workflow at the front end to prevent future denials and aggressively appeal insurance rejections at every level until you get paid. We don't give up—neither do our appeals.
Comprehensive denial management from root-cause analysis to prevention
Deep-dive analysis of every denial to identify root causes. Is it coding, eligibility, documentation, pre-authorization, or medical necessity? We categorize all denials by type and trend.
Correction of claim data and filing of multi-level appeals to payers. Level I internal review appeals. Level II peer-to-peer reviews with actual medical directors. Level III external appeals when necessary.
Updating front-office workflows, billing processes, and clinical documentation to stop the same denial from repeating. Prevention is the best appeal.
Expert resolution for every denial reason and category
Patient not eligible, coverage lapsed, or pre-authorization not obtained. We verify coverage and resolve eligibility issues quickly.
Invalid procedure code, incorrect modifier, or bundling issues. Our AAPC-certified coders correct coding errors and resubmit.
Insufficient medical necessity documentation or missing clinical notes. We gather missing documents and resubmit with Level II appeals.
Payer disputes medical necessity. We file peer-to-peer reviews with medical directors to overturn these denials.
Claims submitted outside the timely filing window. We request timely filing waivers and negotiate reinstatement of claims.
Pre-authorization required, service not covered, duplicate claims, or other reasons. We investigate and appeal strategically.
Measurable improvements in revenue recovery and denial rates
Recover denied claims that were previously written off. Every dollar recovered drops directly to your bottom line.
Reduce your denial rate from 10-12% down to 2-3% through prevention strategies and workflow improvements.
Your billing staff is freed from chasing denials and can focus on processing new claims efficiently.
Claims resolved weeks or months faster through aggressive appeals and direct payer negotiation.
Real-time denial tracking reports showing status of all appeals and resolution progress.
Proactive measures prevent future denials. Fix the workflow so claims are approved the first time.
Of all denied claims we appeal are successfully overturned
Recovered for clients over the past 5 years
From typical industry average down to 2-3%
Resolution from denial to payment or successful appeal
Comprehensive approach to stop, resolve, and prevent denials
Real-time tracking of all denials by reason, payer, and department. Weekly reports show trends and patterns.
Deep analysis of why claims are denied. Identify systemic issues in coding, documentation, or eligibility verification.
Strategic appeals at Level I, Level II peer-to-peer, and Level III external review when necessary.
Direct negotiation with payer representatives to resolve complex denials and policy interpretation disputes.
Implement preventive measures to stop recurrence of the same denial. Better documentation, verification, and coding.
Training your team on denial prevention best practices and proper documentation standards.
Let OrbixRCM aggressively pursue your denied claims while we implement prevention strategies to stop future denials. Schedule your free denial analysis today.
Get Your Free Denial Analysis