Denial Management
A denied claim is not the end, it's a starting point. ProtoMed denial management services investigates every denial, corrects the root cause, and resubmits with the documentation needed to get paid. We also catch the issues driving the medical claims denials before they happen, so your practice stops losing revenue it has already earned.
98%+
Clean Claim Rate
100% of denials investigated and resolved in under 30 days on average so you recover the revenue you've already earned.
The Challenge
Most practices treat denials as a billing problem: record, resubmit, move on. But if the underlying cause isn't fixed, the same denial comes back on the next claim, and the one after that.
ProtoMed takes a different approach. We investigate every denial to find what caused it, correct it at the source, and build the prevention strategy that stops it from recurring.
Most practices treat denials as a billing problem: record, resubmit, move on.
But if the underlying cause isn't fixed, the same denial comes back on the next claim, and the one after that.
Every unworked denial is money your practice has already earned but may never collect.
What We Do
We investigate every denial to find what caused it, correct it at the source, and build the prevention strategy that stops it from recurring.
We don't just recode and resubmit. Every denied claim is reviewed to identify the exact reason whether it's a coding error, missing authorization, eligibility issue, or payer-specific rule so the fix is permanent, not temporary.
The most effective denial management happens before a claim is ever submitted. We review every claim for payer compliance, coding accuracy, and documentation completeness before it goes out catching the errors that would have caused a denial.
Every recoverable denial gets a properly documented appeal submitted within payer-required timeframes. We build each appeal with the clinical justification and supporting documentation needed to overturn the decision and recover the payment.
We monitor your denial patterns by payer, code type, and service line to identify systemic problems. You receive clear denial management reports showing denial rates, recovery outcomes, and the corrective actions taken so improvements are visible and measurable.
Old unpaid denials sitting in your A/R are recoverable revenue. Our team works through your backlog of aged denied claims, prioritizing those with the highest recovery potential and pursuing each one until it's resolved or exhausted.
Cardiology modifiers, behavioral health medical necessity, orthopedic documentation, OB/GYN global billing every specialty has its own denial patterns. Our team knows the specific payer rules and documentation standards that govern your field.
Denial Management Services That Delivers Results
98%+
Clean Claim Rate
< 30
Days
Average Denial Resolution
100%
Denials Investigated
30+
Specialties Served
Every unworked denial is money your practice has already earned but may never collect. ProtoMed investigates every denial, appeals every recoverable claim, and fixes the root cause so the same issue doesn't cost you twice.
A ProtoMed denial specialist will reach out within 24 hours to review your current denial volume and recovery opportunities.
