AI-based denial prediction
Healthcare Denial Management Services to Recover Lost Revenue
Our denial management services are built to reduce claim denials, accelerate A/R recovery, and improve cash flow for your practice or RCM operations.
Medicare, Medicaid & commercial payer coverage
Experienced specialists in state, federal, and commercial payer denials
AI-driven denial detection, correction, and recovery workflows
Outsourcing denial management to our billing specialists means you save time, money, and resources.
Why Healthcare Providers Lose Revenue to Claim Denials
Denied claims are rarely random — they follow predictable patterns across payers and specialties. Common causes include:
Eligibility verification failures
Incomplete or missing documentation (CO-16)
Coding and modifier errors (CPT/ICD/NCCI issues)
Missing or incorrect prior authorizations
Medical necessity denials (CO-50)
Timely filing violations (CO-29)
Many Claim Denials Are Preventable and How We Stop Them
Initial claim denials rose to 11.81% of claims in 2024, according to Kodiak Solutions data from 2,100+ hospitals and 300,000 physicians (Kodiak Solutions via Business Wire, May 21, 2025).
Denied insurance claims can be frustrating. They take time, increase costs, and interrupt the flow of your revenue cycle. Many denials can be prevented, and many of the rest can be corrected or appealed. Many come from simple oversights during claim submission. Our denial management solutions are designed to minimize these errors and help your organization recover payments efficiently.
We provide medical claim denial prevention through:
Categorizing denials for quick resolution
Identifying the root cause of each denial
Pre-auditing claims before submission
Submitting corrected claims on time
Automated denial management software
Our Denial Management Services
Medical Billing Denial Management
Fix coding, modifier, and billing errors before they turn into denials.
Claim Denial Recovery Services
Correct, resubmit, and appeal denied claims for faster reimbursement.
Insurance Claim Denial Management
Handle payer-specific denials across all insurance companies.
Insurance Denial Appeal Services
Prepare payer-specific appeals using clinical and billing documentation.
Medical Claim Denial Resolution
Resolve denied claims using structured appeal workflows.
Prior Authorization Denial Management
Resolve missing, expired, and incorrect authorization denials.
Clinical Denial Management
Appeals are supported using available clinical and billing documentation.
Medicare Denial Management
Apply LCD/NCD compliance rules and MAC-specific workflows.
Medicaid Denial Management
Manage state-specific Medicaid billing and denial rules.
Our Denial Workflow, Step by Step
Every denial goes through the same five steps, from the remittance to the fix that stops it coming back.
- 1
Collect
We pull denials from your ERAs and payer portals.
- 2
Sort
We group denials by CARC/RARC code and dollar value and set a deadline for each one.
- 3
Correct
Claims with fixable errors, such as missing information, a wrong modifier or coordination of benefits, are corrected and resubmitted.
- 4
Appeal
Medical-necessity and authorization denials are appealed with records. Medicare redeterminations are filed within 120 days of receiving the initial determination.
- 5
Prevent
Each month we report root causes and fix the front-end step behind them: eligibility, authorization or coding.
CARC & RARC Denial Intelligence
We analyze denial patterns using CARC and RARC codes to identify root causes.
Common codes include:
Each code represents a distinct denial pattern. Mapping these patterns lets us address the root cause instead of chasing one-off resubmissions. This allows targeted denial prevention instead of generic appeal handling.
- CO-50
Medical necessity denial
- CO-16
Missing information
- CO-4
Procedure code inconsistent with the modifier
- CO-97
Bundling issue
- CO-29
Timely filing
- CO-22
Coordination of benefits
Payer-Specific Denial Management
Denial behavior varies significantly by payer.
Medicare Denial Management
LCD/NCD compliance and MAC-specific rules.
Medicaid Denial Management
State-specific billing variations.
Commercial Payers (UHC, Aetna, BCBS)
Commercial payers: each plan has its own medical policies and appeal steps. We follow the payer's written policy for each appeal.
We apply payer-specific appeal strategies, not generic submissions.
Who We Serve Denial Management Services
Group Practices
Managing denials across different specialties can be overwhelming. Our tools bring every denial into one work queue and track each appeal, which takes pressure off your staff.
Claim and Denial Management Across Multiple Specialties
We deliver claim and denial management services for practices across many specialties, covering everything from cardiology, orthopedics, and radiology to behavioral health, surgery, and beyond.
Why Choose Dastify Solutions?
We focus on reducing the administrative burden while improving financial outcomes.
Specialized Expertise
You get a team that works on denials every day, using payer rules and appeal strategies to secure more approvals.
Greater Accuracy
We strengthen claims at submission, reducing avoidable errors that often turn into denials.
Lower Costs
Outsourcing denial management services saves on hiring and training while improving recovery of outstanding claims.
Compliance You Can Trust
Our team stays up-to-date with Medicare, Medicaid, and commercial payer changes to ensure claims remain compliant.
Actionable Insights
Detailed reporting highlights denial trends and provides clear strategies for prevention.
Scalable Support
As denial volumes change, our support adjusts — no extra staff needed, just what fits your practice.
Frequently Asked Questions
What experience do you have resolving claim denials across different payers and specialties?
We handle denials for commercial payers, Medicare, and Medicaid across many specialties. Our team includes experienced coders and revenue cycle professionals with payer- and specialty-specific expertise.
How does your denial management process reduce denial rates and accelerate reimbursements?
We triage denials by priority, identify root causes, correct billing or documentation issues, and submit targeted appeals so clean claims get paid faster.
Which medical specialties do you support, and do you handle specialty-specific coding issues?
Yes. We support a broad range of specialties, including cardiology, orthopedics, radiology, behavioral health, and more, and we apply specialty-specific coding and payer rules.
What technology and analytics do you use to prioritize and automate denial workflows?
Available automation varies by client system, payer access, available data, and contracted workflow.
Can you share case studies or performance metrics that demonstrate your denial recovery results?
Yes. One example: Chicago Infectious Disease's denial rate went from 16% to 10%. The full case study is on our case studies page.
How do you ensure compliance with payer rules, Medicare, and Medicaid during appeals?
We follow payer and federal guidelines, maintain complete documentation and audit trails, and use trained staff and regular compliance reviews to reduce audit risk.
What security and data-protection measures do you use to safeguard patient and billing information?
We sign a Business Associate Agreement before any access. Our team connects over a dedicated static IP with multi-factor authentication and role-based access, and works inside a remote session on U.S.-hosted Microsoft Azure systems with no ability to download patient data. We run a 24/7 security operations center and notify clients of a breach within 24 hours. Our latest third-party HIPAA/HITECH Security Risk Assessment was completed by Brian L. Tuttle, Inc. on September 14, 2026.
How are your denial management services priced, and what ROI can clients expect?
Denial management is included in our full-service plans from 3.99% of collections (2.99% for group practices). Denial-only work is quoted separately. We give you a written estimate after reviewing your denial data.
Who works our denials?
Our offshore team reads each denial code, corrects claims and prepares appeals from our secured operations office, never from home. Our U.S. leadership team oversees the account, and coding-related denials can be escalated to Stephanie Jason, CPC, CPMA, CCS.
Faster Appeals. Fewer Aged Accounts. More Revenue.
Recover lost revenue faster with structured denial management services designed for healthcare providers and RCM organizations.