Jul 30, 2026
How Much Does It Cost to Outsource Medical Billing?
- Medical Billing
- OneMed Billing
The problem
Writing off denials too soon?
When denials go unchallenged you aren’t just losing revenue — you’re giving up money the practice has already earned. Many denied claims are appealable, but appealing properly takes time most billing teams simply don’t have, so the queue grows and the oldest ones quietly expire.
Our team takes over the appeals queue. We review each denial, decide whether it’s worth fighting, gather the documentation, write payer-specific letters, and follow through until the claim is resolved one way or the other.
Unworked queue
expires
Grows until the windows close
Triaged queue
resolved
Fought, or closed on purpose
Either outcome is fine. Expiry isn’t an outcome.
Why Most Appeals Fail
An appeal isn't a resubmission. It's an argument.
Sending the same claim back with a covering note asking the payer to reconsider is not an appeal — it's a request, and it gets treated like one. A payer overturns a denial when someone addresses the specific reason given, cites the plan's own policy, attaches the clinical evidence that policy requires, and submits it the way that payer demands. Most appeals lose on the paperwork, not on the merits.
THE TEMPLATE
“Please reconsider this claim.”
- Addresses the specific denial reason
- Cites the payer's own policy
- Attaches the clinical evidence
- Sent by the route that payer requires
DENIAL UPHELD
THE CASE
Built for this payer, this denial
- Answers the exact reason code given
- Quotes the plan's own medical policy
- Notes, imaging and orders attached
- Filed through the required channel
DENIAL OVERTURNED
That is the entire service — and it is why templates don't work.
We'll also tell you which denials not to appeal
Step two of our process is separating appealable denials from ones that are simply correct. That distinction gets skipped surprisingly often, because filing an appeal feels like doing something.
It isn't free. Appealing a denial that won't be overturned costs you money, delays a write-off you were always going to take, and spends credibility with a payer you'll be appealing to again next month. When a denial is correct we say so, close it, and put the effort into the ones that can actually be won.
WHAT'S INCLUDED
We manage the entire appeal lifecycle
From the initial denial analysis to final resolution — everything needed to give each claim its best chance.
Review of denial codes and claim data
We start from what the payer actually said, not from what the claim looks like — the reason code, the remark code, and the claim history together.
Appealable vs non-appealable triage
Every denial is sorted before any work begins. Correct denials get closed with an explanation rather than appealed for the sake of it.
Detailed appeal letters with supporting evidence
Written for that payer and that denial reason, quoting the relevant policy and attaching the records it requires.
Submission via portal, fax or mail
Filed through the channel that payer accepts, with tracking and reference numbers retained for follow-up.
Peer-to-peer and provider coordination
Where a payer wants a clinical conversation, we schedule it and brief your provider with the documentation and policy language beforehand.
Audit logs and documentation archive
Every appeal, submission and outcome archived, so the evidence exists if a payer or auditor asks later.
HOW IT WORKS
Our step-by-step appeal process
Each denied claim moves along a clear path from problem to payment.
Denial received and reviewed
The denial is pulled in and read against the claim, the documentation, and the payer’s stated reason.
1
2
Root cause and appeal eligibility determined
We establish why it was denied and whether it’s genuinely appealable — including how long is left in the window.
Appeal letter created and documentation gathered
The argument is built around that payer’s policy, with clinical records, orders and notes collected to support it.
3
4
Submission completed with tracking
Filed through the payer’s required route, with the reference number recorded against the case.
Follow-up with the payer begins
Chased through to a decision rather than left in a queue, with escalation where a payer goes quiet.
5
6
Final status logged and reported
Outcome recorded by payer and denial reason, and reported back so patterns become visible.
Depth
Appeals that go beyond the basics
We handle the appeals that need more than a templated letter — prior authorization disputes, medical necessity, and coding-related denials, where the argument depends on clinical detail rather than a form field.
Where a payer wants a peer-to-peer review, we coordinate it and prepare the provider with the documentation and the policy language in advance. Every appeal is customized to the specific expectations of that payer, across Medicare, Medicaid and commercial plans, and across specialties including behavioral health, infusion, DME and surgical services.
Working through the whole denial file rather than just the complex ones? That's Denial Management.
Medical necessity
Prior authorization dispute
Coding & bundling
Peer-to-peer review
The ones a template can't win.
Appeal log
daily
Overturned — paid in full
closedFiled — awaiting payer response
trackingHigh-dollar — window closing
alertReviewed — not appealable
closedPartial reversal — balance billed
closedIllustrative log view.
Visibility
Know what was appealed, when, and why
Full visibility into every appeal submitted — the detail, the follow-ups, and the outcome — so you never have to guess where something stands.
- Daily appeal logs with denial codes and payer references
- Reversal and resolution status as it changes
- Reports on win rates and appeal reasons
- Alerts on time-sensitive or high-dollar appeals
- Documentation archives for future audits or compliance
WHY ONEMED
Appeal support built for complex denials
Software can flag that a claim was denied. Writing the argument that overturns it is a different job entirely.
| Capability | In-house staff | Software only | OneMed Billing |
|---|---|---|---|
| Custom appeal letter writing | Limited by time | No | Yes |
| Payer-specific documentation | Rare | No | Yes |
| Peer-to-peer scheduling support | No | No | Yes |
| Filed within 1–2 days of review | Sometimes | No | Yes |
| Appealable vs non-appealable triage | Inconsistent | No | Yes, in writing |
| Denial root-cause tracking | Basic | None | Full reports |
We don’t just file appeals — we decide which ones deserve one, then build them properly.
RESULTS
Real practices, real recovery
| Metric | Before OneMed | After OneMed |
|---|---|---|
| Appeal win rate | 39% | 76% |
| Time to file an appeal | 5 to 7 days | 1 to 2 days |
| Monthly recovered revenue | Low | Consistent growth |
| Denials written off | Frequent | Reduced significantly |
“Our appeals were inconsistent, and many denials just sat in the system. Since partnering with OneMed, we’ve recovered thousands in claims we thought were lost.”— RCM Director, Multispecialty Group
Representative results across onboarded practices. Actual outcomes vary by specialty, payer mix, and denial type.
GET STARTED
Hand us your appeals queue
Send us your denied claims. We’ll tell you which are genuinely appealable, which windows are closing, and what evidence each one needs to stand a chance.
- No-obligation triage of your current appeals queue
- BAA executed before any clinical records are shared
- Medicare, Medicaid and commercial payers, all 50 states
Prefer to talk now?
(315) 366-8242
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Frequently Asked
Common questions.
Do you track outcomes?
Yes. Every appeal is tracked through to resolution, and results are logged and reported.
Do you write and submit appeal letters?
Yes. We create custom letters and submit them based on the payer’s preferred method (portal, fax, or mail).
Can you handle medical necessity or clinical appeals?
Absolutely. We coordinate with providers for documentation and can support peer-to-peer processes.
What payers do you support?
We manage appeals for Medicare, Medicaid, and commercial payers across all 50 states.
How quickly can you file appeals?
Most appeals are submitted within 24 to 48 hours after denial review.
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