Denial management that recovers revenue and stops repeat denials
Every denial has a reason code and a fix. ClaimEdgeSolutions works each one, files appeals with the right clinical and contractual support, and tracks root causes so the same denial doesn't come back next month.
Common problems we fix
If any of these are happening in your practice, revenue is slipping away every week.
- Denials written off because no one had time to appeal
- The same CARC codes (CO-16, CO-197, CO-50) showing up every month
- Appeal deadlines missed across dozens of payers
- No data on which payers or providers drive denials
How ClaimEdgeSolutions handles denial management
Denial triage
Every denial is categorized by CARC/RARC code, payer and dollar value the day it posts.
Corrected claims
Coding, modifier and demographic errors are fixed and resubmitted fast.
Written appeals
Level 1 and 2 appeals with medical necessity letters and supporting records.
Root-cause analysis
Trends by payer, provider, code and location with a clear fix for each.
Front-end prevention
Eligibility, authorization and registration fixes so denials stop at the source.
Staff feedback
Short, practical training for your front desk and providers.
Specialists who own your denial management
You get named people who learn your providers, payers and workflows, not a rotating queue. Every open item has an owner and a deadline.
- Denial triage
- Corrected claims
- Written appeals
The metrics we report on
Your monthly report tracks these numbers for this service, alongside your overall revenue cycle KPIs.
Share of claims denied
Overturned denials
Denial to payment
From audit to results in four steps
Free revenue audit
We review your A/R aging, denial history, payer mix and coding patterns, then show you what is recoverable.
Onboarding
BAA signed, secure system access set up, workflows mapped and your dedicated team assigned.
Daily operations
Claims, payments, denials, A/R and patient billing are worked every business day.
Monthly review
A KPI report and a call with your account manager covering results and next steps.
Often paired with Denial Management
Medical Billing & Coding
Certified coders and billers who turn every encounter into a clean, compliant claim.
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Revenue Cycle Management
End-to-end RCM from patient scheduling to the final zero balance.
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Credentialing & Enrollment
Get providers enrolled with payers faster, and keep them active.
Explore serviceAvailable for every specialty, including
Frequently asked questions
Straight answers about how ClaimEdgeSolutions works with your practice.
Ask us anything01Which denials do you work?
All of them: clinical, technical, eligibility, authorization, timely filing, coding and bundling denials across commercial, Medicare, Medicaid and workers' comp payers.
02Do you appeal old denials?
Yes, as long as the payer's appeal window is still open. We prioritize by value and deadline.
03How do you prevent repeat denials?
We trace each denial to the step where it started and fix that step: eligibility, authorization, coding or documentation.
04Will we see the results?
Your monthly report shows denial rate, top denial reasons and recovered dollars.
05Do you sign a Business Associate Agreement?
Yes. A BAA is signed with every client before we access any protected health information.
See where your revenue is leaking
Get a free, no-obligation revenue audit. We review your A/R, denials and coding patterns and show you exactly what is recoverable.