Denial Recovery Services

Denial recovery is the comprehensive process for addressing and resolving insurance claim denials. This process begins by identifying denied claims and pinpointing the specific reasons for each denial, such as coding errors, missing documentation, or eligibility issues. Specialists then analyze the root causes, gather necessary information or corrections, and either appeal the payer’s decision or resubmit a corrected claim.

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Specialized technology empowers organizations to track the status of appeals and resubmissions and ensure timely resolution and compliance with payer deadlines. By uncovering trends and reasons behind denials, denial recovery not only helps recover lost revenue but also provides valuable insights for process improvement, ultimately minimizing future denials and supporting stronger financial health for provider organizations.

Three main reasons:

• Resource and staffing constraints: Increasing contract complexity and restrictions, along with deliberate reimbursement obfuscation on the payer’s part, mean denial management requires extensive staff capacity. In the current environment, revenue cycle teams struggle to find sufficient talent to handle these tasks.
• Low confidence in success: Revenue cycle staff often indicate a low confidence in success due to the difficulty in appealing denials. Education of best practices can help to empower staff to tackle denial recovery.
• Prioritization challenges: Revenue cycle teams are often inundated with a long list of tasks, and different staff members have competing priorities. The urgency of other projects makes it tough to prioritize denial recovery, even as backlogs grow.

Most EHR and billing platforms focus on documentation, scheduling, and basic claims submission but lack the analytical depth and specialized workflow automation needed to systematically identify, analyze, and overturn denied claims.

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Denial management features in these systems are often recent add-ons, and they typically do not account for the full complexity of payer rules, contract nuances, or the root causes behind denials — such as coding subtleties, documentation gaps, or payer-specific appeal requirements. As a result, providers relying solely on EHR or billing systems often miss opportunities to recover revenue from denied claims, and staff are forced into labor-intensive manual reviews and appeals that are prone to error and inefficiency. In contrast, dedicated denial recovery solutions are purpose-built to automate denial identification, root cause analysis, and appeal submission. This technology in combination with recovery experts’ deep contract knowledge and payer expertise maximizes overturn rates and reduces administrative burden. Relying exclusively on your EHR or billing system for denial recovery can leave significant revenue unrecovered and expose your organization to ongoing financial risk.

Provider organizations handling high volumes of complex claims and navigating numerous payer contracts with diverse reimbursement models benefit most from a dual strategy of advanced software and expert services.

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These organizations frequently encounter heavy administrative workloads, complicated contract provisions, and challenges with accurate coding and documentation. These factors make manual denial detection and recovery both inefficient and prone to error. By integrating technology-driven denial identification combined with the specialized expertise of payer reimbursement professionals, providers can quickly and accurately detect, analyze, and overturn denials.

MD Clarity stands out from competitors in denial recovery by combining its purpose-built software to streamline denial management with its in-house denial recovery experts’ deep knowledge of payer reimbursement methods. Its ability to handle denials from notification to recovery makes it a true end-to-end denials solution. When MD Clarity’s experienced denial recovery experts leverage its advanced RevFind technology, providers resolve denials quickly and at a positive ROI. Many provider organizations using denial recovery software lack the option to partner with recovery experts altogether.

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RevFind simulates payer claim adjudication systems to systematically identify denied claims and variances at a granular level. This precision uncovers hidden revenue opportunities that many competitors miss by only providing surface-level views. The platform offers robust analytics to drill down into denial trends by payer, code, denial reason, and other key metrics. These granular insights enable providers to identify systemic issues and operational inefficiencies that lead to denials, allowing targeted interventions to decrease first past denial rates on an ongoing basis.

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Further, unlike competitors focused solely on denial automation, MD Clarity addresses multiple sources of revenue leakage, including underpayments, contract optimization, and patient financial responsibility, providing a more comprehensive revenue recovery solution.

Our contingency-based fee structure means that we are compensated when you recover denials. This performance-based approach aligns our incentives with your organization’s financial performance.