Our Denial Management Services
1) Rapid Triage & Prioritization
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Enables automated processing of denials and ERA/EOB data to improve accuracy and efficiency.
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Score denials by expected recoverable value and likelihood of success.
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Route top-priority items to specialist appeals teams immediately.
2) Root-Cause Analysis (RCA)
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Aggregate denials by payer, CPT/HCPCS, provider, and denial code.
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Identify upstream causes: eligibility failures, coding errors, missing documentation, incorrect modifiers, bundling issues, or payer-specific rules.
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Produce an RCA report with recommended process or training changes.
3) Appeals & Corrections
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Create full appeal packets with clinical documentation, cited guidelines, and payer policy citations.
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Submit corrected claims or coordinate re-openings and follow-ups.
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Manage peer-to-peer requests and physician sign-offs when needed.
4) Clinical Documentation & Coding Remediation
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Provide provider-facing documentation tips and CDI recommendations to close gaps that lead to denials.
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Conduct coder retraining and real-time coder feedback loops to reduce coding-related denials.
5) Payer Negotiation & Escalation Support
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Actively manage payer reps for denials that need escalation or policy clarification.
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Document outcomes and update internal payer rule sets to prevent repeat issues.
6) Technology & Automation (AI-assisted)
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Denial-pattern detection and predictive scoring to target the highest ROI appeals.
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Auto-assembly of appeal packets from chart extracts (OCR + NLP) with human review before submission.
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Automated follow-up reminders, tracking, and appeal-status dashboards.
7) Process Fixes & Preventive Controls
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Update claim-scrub rules, checklists, and front-end verification scripts.
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Implement payer-specific billing rules in your PMS/clearinghouse.
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Create playbooks for common denials so front-desk, billing, and clinical staff know exactly what to do.
8) Reporting & Continuous Improvement
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Weekly recovery dashboards and monthly RCA deep dives.
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KPI monitoring: denial rate, time-to-resolution, recovered dollars, appeal win rate, and denial recurrence rate.
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Quarterly process improvement sprints guided by data.
Why practices pick our denial management
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Prioritized recovery: We go after high-dollar and high-likelihood recoveries first.
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Root-cause focus: Fix front-end and clinical documentation problems so the same denials stop happening.
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Human + AI: Automation triages and surfaces patterns; humans prepare appeals and make clinical judgements.
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Transparent metrics: Clear dashboards and weekly action lists so your team knows what we fixed and why.
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Seamless handoff: Works as a stand-alone denial team or fully integrated with your RCM partner.
Why tackling denials matters
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Denied claims reduce cashflow and increase days in AR.
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Repeated denials waste staff time on rework instead of revenue-generating tasks.
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Some denials are recoverable with an appeal or a corrected claim; many are not if you don’t act quickly.
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Systemic denial patterns point to predictable process or documentation failures that, once fixed, create lasting gains.
A strong denial-management program turns denials from a reactive scramble into a strategic lever for revenue improvement.
What is Denial Management
Denial management is the full lifecycle of handling claims that payers reject or partially pay: categorize the denial, determine why it was denied, fix the root problem or prepare an appeal, resubmit or escalate, and implement preventive changes so the denial doesn’t repeat. It’s recovery plus prevention — cash today, fewer problems tomorrow.
Common Reasons for Medical Claim Denials
❌ Missing or inaccurate patient demographics
❌ Old or incorrect insurance details
❌ Missing or incorrect approval/referral
❌ Uncovered or outside of network care
❌ Incorrect CPT/ICD-10 codes or modifiers
❌ absence of supporting medical evidence
❌ Claim that is duplicated or previously processed.
❌ Issues with prompt submission
❌ Changes to payer rules not reflected in billing processes
Every day you are missing money if you're not aggressively monitoring and addressing these problems.
Denial Management Services
Denials are more than paperwork — they’re delayed cash, wasted staff hours, and stress. At Sirius Solutions Global we stop the cycle: we recover payable claims, eliminate repeat denial causes, and build simpler workflows so your revenue actually arrives on time. Our approach blends experienced appeals specialists, certified coders, payer-savvy analysts, and AI that highlights the highest-impact cases.
📉The Financial Impact of Claim Denials
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1 in 5 claims is denied on the first submission
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Up to 10% of annual revenue is lost due to unworked denials
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Denials add 16–30 days to your average reimbursement time
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Most practices recover only 20–30% of denied claims — we target 70–90%+
Deliverables — what you get, month-to-month
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Detailed weekly denial triage dashboard (top deniers, open appeals, recovery pipeline).
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Monthly RCA report and prioritized action list.
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Appeal packets and resubmission logs with payer confirmations.
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KPI dashboard (denial rate, appeal win rate, recovered revenue, avg days-to-resolution).
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Provider and staff training materials tied to observed issues.
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Updated payer-rule library for your clearinghouse/PMS.
Ready to streamline your revenue cycle management?
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Common denial types we fix
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Eligibility/coverage denials — fix with pre-visit verification, quick payer callbacks, and corrected claims.
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Coding/modifier denials — root-cause coder retraining, modifier corrections, and re-submission.
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Medical necessity / documentation denials — build clinical packets, cite evidence/guidelines, escalate to peer-to-peer when required.
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Bundling & LCD denials — re-evaluate code combinations and split-billing when appropriate.
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Timely filing & payer processing denials — rapid appeals or payer escalation with documented proof of submission dates.
Take Control of Your Revenue — Verify Before You Bill
Most practices lack the time, resources, or personnel to pursue every claim; let's be honest. You can concentrate on patient care with Sirius Solutions Global's competent denial management staff while we concentrate on revenue recovery and defense.
Schedule your complimentary denial analysis right away to see how much money your business might be recovering.