Back-End · Appeal Management

Fight denials. Recover revenue. Get paid what you’ve earned.

We manage the full appeal process by reviewing the denial, deciding whether it can realistically be appealed, building the case with the right clinical evidence, submitting it in the format the payer requires, and following it through to resolution. We do not use generic templates, and we do not file appeals just to clear a queue.

Payer-specific letters Evidence attached Peer-to-peer support Filed in 24–48 hours

Talk to an appeal specialist (315) 366-8242

Appeal case file

Denial reason Medical necessity not established

Appealable and still within the filing window.

22d left

Payer’s own policy cited

clause ref

Clinical records attached

4 docs

Peer-to-peer scheduled

Thu 10:00

Submitted via payer portal

ref on file

Outcome Overturned

2 days to file

A case,
not a letter

The problem

Writing off denials too soon?

When denials are not challenged, the practice is not just losing revenue. It is giving up payment for work that was already done. Many denied claims can be appealed, but proper appeals take time, and most billing teams do not have enough capacity to keep up. That is why appeal queues grow and older claims 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

Grows until the windows close

expires

Triaged queue

Fought, or closed on purpose

resolved

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 short note is not a real appeal. It is only a request for reconsideration, and payers often treat it that way. A strong appeal addresses the exact denial reason, cites the payer's own policy, includes the clinical evidence that policy requires, and follows the payer's submission rules. Most appeals fail because the paperwork is weak, not because the case itself is unwinnable.

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 why this service exists, and that is why templates do not 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

We handle every step from initial denial review through final resolution so each claim has the strongest possible chance of being overturned.

Review of denial codes and claim data

We start with what the payer actually said, including the reason code, remark code, and claim history, not just what the claim looks like at a glance.

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.

Talk to an appeal specialist

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.

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.

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.

Final status logged and reported

Outcome recorded by payer and denial reason, and reported back so patterns become visible.

Request a demo of our appeal workflow

Depth

Appeals that go beyond the basics

We focus on appeals that need more than a standard letter, including prior authorization disputes, medical necessity denials, and coding-related denials where the outcome depends on clinical detail.

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

clinical record required

Prior authorization dispute

retro-auth request

Coding & bundling

documentation of distinct service

Peer-to-peer review

provider prepared & scheduled

The ones a template can't win.

Appeal log daily

Overturned - paid in full

closed

Filed - awaiting payer response

tracking

High-dollar - window closing

alert

Reviewed - not appealable

closed

Partial reversal - balance billed

closed

Illustrative log view.

Visibility

Know what was appealed, when, and why

You get full visibility into every appeal, including the issue, the follow-up activity, and the outcome, so you always know where it 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

Talk to a specialist today

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 do not file every appeal automatically. We decide which claims are worth appealing and then build each one 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

Schedule a 15-minutes call

Our team will review your request and respond within one business day. Your information will be kept confidential and used only to address your inquiry.

Request received.

Thank you. A member of our team will review your information and be in touch within one business day. We look forward to showing you what your practice should be collecting.

Frequently Asked