What are the three types of denials?

Claim denials typically fall into three categories: administrative, clinical, and policy-related. Most denials stem from administrative issues like incorrect patient info, missing documentation, or coding errors.

What are the most common reasons for claim denials?

They include missing documentation, incorrect codes, eligibility issues, lack of prior authorization, or services not covered under the patient’s plan.

What’s the difference between a denied and rejected claim?

A rejected claim has format or data issues and never reaches processing, while a denied claim is reviewed and then not paid due to coverage or billing errors.

How do denial management services help reduce future denials?

They analyze patterns, identify root causes, and adjust workflows or training to prevent the same errors from happening again.

Denial Management Services | Reduce Denials, Recover Revenue

Lower Denial Rates

Faster Recoveries

Root-Cause Resolution

30+ Specialties Served

Why Claims Are Commonly Denied

Claim denials rarely happen because of a single mistake. In most practices, denials are the result of small process gaps, changing payer rules, and limited time to manage follow-ups consistently. When these issues add up, even clean claims can be delayed or denied unnecessarily. Many healthcare providers experience claim rejections due to coding mistakes, missing documentation, eligibility issues, and authorization errors. Understanding the real reasons behind claim denials can help prevent recurring problems and improve reimbursement success.

Stop Claim Denials from Hurting Your Revenue

Incomplete or Documentation

Missing clinical notes, signatures, or supporting records often lead to medical necessity or documentation-related denials.

Authorization mismatches

Claims denied due to missing, expired, or incorrect prior authorizations tied to the procedure, diagnosis, or service location.

Coding inconsistencies

CPT, ICD-10, or modifier errors that don’t align with payer guidelines or billed services, which are among the most common denial codes.

Payer-specific rule changes

Frequent updates to payer policies that are easy to miss without dedicated monitoring and review.

Missed appeal deadlines

Denials that could be overturned but remain unpaid due to delayed or missed appeal submissions.

Limited staff bandwidth

Internal teams balancing multiple responsibilities may not have the time to track, appeal, and follow up on every denied claim.

What Our Denial Management Services Cover

Denials don’t all happen for the same reason, and they shouldn’t all be handled the same way. We work each denied claim from start to finish and following through until it’s resolved. The goal is simple:

Step 01

Find the real cause behind each denial

Step 02

Write payer-ready appeals with the right support

Step 03

Correct errors and resubmit clean claims fast

Step 04

Collect missing docs so claims don’t stall

Step 05

Escalate stuck claims and stop repeat denials

Types of Claim Denials We Manage

Eligibility and Coverage Denials

Medical Necessity Denials

Timely Filing Denials

Non-Covered Service Denials

Claim Submission and Clearinghouse Rejections

Prior Authorization and Referral Denials

Coding and Modifier Denials

Duplicate and Bundling Denials

Documentation-Related Denials

How We Work With Your Existing Billing Workflow

Our denial management support is designed to integrate smoothly with your current billing operations. We don’t disrupt your workflow or replace your staff; we handle the time-intensive denial work while keeping your team informed and in control.

What Your Team Provides

Access to EOBs, ERAs, and denial details
Secure system or report access (as applicable)
Escalation approvals for high-value or complex appeals
Practice-specific guidelines or payer preferences

What OneMed Manages

Denial analysis and root-cause identification
Appeal preparation and submission with supporting documentation
Payer follow-ups via portals, phone, and written communication
Deadline tracking to prevent missed appeal windows
Status monitoring and escalation management
Clear reporting by payer, denial reason, and outcome

How We Work Within Your Existing Billing Workflow?

Your team stays in control. We handle the follow-through.

Denial Reduction Results You Can Measure

Metric

Denial rate

Average time to resolve a denial

Percentage of appeals won

Denials written off

Before OneMed

12%

22 days

41%

High

After OneMed

8 days

78%

Minimal

We saw a clear drop in our denial rate and a faster turnaround on appeals after bringing OneMed in. They’re organized, they document everything, and they communicate status updates without us having to ask. It’s been a huge help for our cash flow.

— Billing Supervisor, Multi-Specialty Clinic

What Makes OneMed Different in Denial Management

Feature

Payer Follow-Up

Authorization & Documentation

Appeals & Payer Rules

Administrative Workload

Denial Resolution & Analysis

In-House Staff

Limited time to work volume; follow-up varies

Often delayed by missing docs and payer rules

Hard to keep up with payer rules

High admin load and strict requirements

Denial work competes with daily billing

Software Only

Flags issues, but can’t appeal or follow up

May track auth, but can’t coordinate documents

Tracks limits, but doesn’t manage appeals

Can store docs, but doesn’t resolve denials

Shows dashboards, but doesn’t close cases

OneMed Billing

Fixes coding errors, submits appeals, follows up with payers

Verifies auth needs, gathers docs, corrects details, resubmits

Aligns documentation, manages appeals, tracks repeat patterns

Collects required paperwork, appeals when needed, tracks payer rules

Tags root causes, clears backlog, speeds follow-up, reports fixes

If you want to understand what’s causing repeat denials across payers, our Medical Billing Audit Services can identify root issues in coding, documentation, and workflow.

Request a Denial Review

Know Exactly Where Every Denial Stands

We provide structured updates so your team always knows which denials are in progress, which are resolved, and which require next steps.

Daily denial status updates

Payer responses and appeal outcomes

Denial reason summaries by payer, code, and category

Weekly review calls for high-impact claims

Shared access to case tracking dashboards (if needed)

Our Simple Yet Effective Process

We handle each denial with precision, from discovery to resolution.

Denial Intake & Claim Capture

Denied claims received from your system or clearinghouse

Denial Review & Categorization

Denial reasons categorized and logged

Corrective Action Planning

Corrective action determined and implemented

Appeal & Correction Submission

Appeal or correction submitted

Active Follow-Up to Resolution

Follow-up completed until claim is paid or closed