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Where the money actually goes
Most denied claims aren’t lost.
Most denied claims aren’t lost.
They’re abandoned.
A denial is not always the final outcome. It is often the payer’s first position, and many denials are overturned when they are challenged properly. The problem is that appeals take time, and many billing teams do not have enough capacity to pursue them consistently. As a result, denials often become write offs even when the revenue could have been recovered.
What happens to a month of denied claims
Not because they would have lost.
Because nobody had time to find out.
The denial
a decision you are entitled to contest
The write-off
a decision made by running out of time
Only one of those two decisions was the payer’s.
These proportions are illustrative, not measured. The actual mix varies by specialty, payer mix, and the billing capacity a practice has. Some denials are valid and should be accepted. The point is that the decision should be made intentionally, not by default.
ROOT CAUSES
Why claims are commonly denied
Most denials do not come from one isolated mistake. They come from small process gaps, changing payer rules, and inconsistent follow-up. Once those problems build up, even clean claims can be delayed or denied.
Incomplete or missing documentation
Missing clinical notes, signatures or supporting records, which surface later as medical necessity or documentation denials.
Authorization mismatches
Missing, expired or incorrect prior authorizations tied to the procedure, diagnosis or service location.
Coding inconsistencies
Procedure, diagnosis or modifier choices that don’t align with payer guidelines or with the services actually billed.
Payer rule changes
Policies update frequently, and they’re easy to miss without someone monitoring them deliberately.
Missed appeal deadlines
Denials that could have been overturned, left unpaid simply because the appeal window closed first.
Limited staff bandwidth
Internal teams juggling several responsibilities rarely have time to track, appeal and follow up on every denied claim.
WHAT'S INCLUDED
What our denial management services cover
Denials don’t all happen for the same reason, so they shouldn’t all be handled the same way. Each denied claim is worked from start to finish, until it’s resolved one way or the other.
Find the real cause behind each denial
Reason codes tell you what happened; they rarely tell you why. Each denial is traced back to the process gap that produced it.
Write payer-ready appeals with the right support
Appeals built around what that payer requires, with the clinical documentation attached rather than referenced.
Correct errors and resubmit clean claims fast
Where a correction is the right route rather than an appeal, the claim is fixed and resubmitted without waiting on an appeals queue.
Collect missing documents so claims don’t stall
We chase the notes, signatures and records the payer is asking for, and tell your team precisely what’s needed.
Escalate stuck claims
Claims that go quiet get escalated to payer supervisors rather than left to sit in a queue.
Stop repeat denials
Every denial is tagged by cause and reported as a trend, so the same failure gets fixed at source.
COVERAGE
Types of claim denials we manage
Each type has a different root cause, a different fix, and a different deadline.
Eligibility and coverage denials
Coverage inactive on the date of service, wrong plan on file, or benefits that never applied to this service.
Medical necessity denials
Some denials happen because the payer questions whether the service was medically necessary. These are often recoverable, but only if the clinical record is submitted with the appeal.
Timely filing denials
Filed outside the payer's window. Often defensible with proof of original submission, which is why documentation matters.
Non-covered service denials
The plan genuinely excludes the service. Some of these are correct, and we will tell you when appealing isn’t worth it.
Prior authorization and referral denials
Some denials happen because authorization was missing, expired, or never linked to the claim. These can often be recovered through a retroauthorization request when the facts support it.
Coding and modifier denials
Code combinations the payer’s edits reject, corrected against the documentation rather than guessed at.
Duplicate and bundling denials
Services treated as already paid or as included in another code, where the record shows they were distinct.
Documentation-related denials
The payer wants records before it will pay. We gather and submit them in the format that payer accepts.
Front-end rejections, triaged
Clearinghouse and payer front-end rejections are separated out and routed to correction, not into an appeals queue.
A clearinghouse rejection or payer front end rejection is not the same as a denial. The claim never reached adjudication, so there is nothing to appeal. It has to be corrected and resubmitted instead. We route those claims into the right workflow rather than wasting time on an appeal that cannot be filed. See Rejection Management.
Working Together
Who does what
We don't replace your staff or take over your systems. We take the time-intensive denial work and keep your team informed and in control.
YOUR TEAM PROVIDES
Access and approvals
- 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
- Clinical documentation only your providers can supply
ONEMED MANAGES
The follow-through
- Denial analysis and root-cause identification
- Appeal preparation and submission with supporting documentation
- Payer follow-ups via portals, phone and written communication
- Deadline tracking, so appeal windows aren't missed
- Status monitoring and escalation management
- Reporting by payer, denial reason and outcome
HOW IT WORKS
From denial intake to root cause
Each denial handled with the same discipline, from discovery through to resolution.
Denial intake and claim capture
Denied claims pulled from your system or clearinghouse, daily or in batches to suit your workflow.
1
2
Denial review and categorization
Every denial reason reviewed, categorized and logged, so the file becomes analysable rather than a pile.
Corrective action planning
We decide the right route for each claim — correction, appeal, additional documentation, or accept and close.
3
4
Appeal and correction submission
Appeals and corrected claims submitted through the payer’s required channel, with reference numbers retained.
Active follow-up to resolution
Followed up until the claim is paid or formally closed, with escalation where a payer goes quiet.
5
6
Trend analysis and provider feedback
Recurring issues flagged back to your team, so the process gap gets closed instead of reappearing next month.
Integration
How we work inside your existing billing workflow
You don't need to change systems or rebuild your billing process to support denial recovery. Whether you use Athena, Kareo, AdvancedMD, Epic or another EHR, we work directly within your existing workflow.
We receive denial files, investigate root causes, prepare appeals, follow up with payers, and send status updates back to your team. Your staff stays informed while every denial is tracked through resolution.
Your EHR
Athena · Kareo AdvancedMD · Epic
denial files
OneMed
appeals · follow-up deadline tracking
No system change. No process rebuild.
We coordinate with your existing billers too.
Denial status board
updated daily
Resolved and paid
closedAppeal filed, awaiting payer
in progressNeeds clinical note from provider
your actionEscalated to payer supervisor
in progressReviewed. Denial was correct and accepted.
closedIllustrative board view.
Visibility
Know exactly where every denial stands
Structured updates so your team always knows which denials are moving, which are resolved, and which are waiting on something only you can provide.
- Daily denial status updates
- Payer responses and appeal outcomes as they land
- Denial reason summaries by payer, code and category
- Weekly review calls for high-impact claims
- Shared access to case tracking dashboards, where useful
WHY ONEMED
What makes OneMed different in denial management
Software can tell you a claim was denied. Closing the case is a different job.
| Capability | In-house staff | Software only | OneMed Billing |
|---|---|---|---|
| Payer follow-up | Limited time to work volume | Flags issues, can’t appeal or follow up | Fixes errors, submits appeals, follows up to a decision |
| Authorization & documentation | Often delayed by missing records | May track, can’t coordinate documents | Verifies needs, gathers records, corrects and resubmits |
| Appeals & payer rules | Hard to keep pace with changes | Tracks limits, doesn’t manage appeals | Aligns documentation, manages appeals, tracks repeat patterns |
| Administrative workload | High, with strict requirements | Stores documents only | Collects paperwork, appeals, tracks payer rules |
| Root cause & analysis | Competes with daily billing | Shows dashboards, doesn’t close cases | Tags causes, clears backlog, reports the fixes |
RESULTS
Denial reduction you can measure
| Metric | Before OneMed | After OneMed |
|---|---|---|
| Denial rate | 12% | 4% |
| Average time to resolve a denial | 22 days | 8 days |
| Appeals won | 41% | 78% |
| Denials written off unworked | High | 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.”— Billing Supervisor, Multi-Specialty Clinic
Representative results across onboarded practices. Actual outcomes vary by specialty, payer mix, and starting backlog.
GET STARTED
Get a denial audit
Send us your denial file and we will sort it by root cause, identify what is still within appeal and filing deadlines, and show you what can still be recovered, including items sitting in backlog.
- No-obligation review of your current denial mix and backlog
- BAA executed before any records are shared
- We offer monthly service pricing or recovery-based pricing, depending on what fits your claim volume best.
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
Common questions.
How much do denial management services cost?
Pricing depends on your denial volume, specialty, and how far back the backlog goes. Most practices choose a monthly service or a recovery-based model. We review your denial mix and recommend the simplest option.
Do you work with denials from all payers?
Yes. We manage denials from Medicare, Medicaid, commercial insurers, and third-party payers across all 50 states.
Can you handle old denials too?
Absolutely. We’ll review your backlog and recover whatever is still within timely filing limits.
How do you send appeal letters?
We submit appeals via payer portals, fax, or mail based on payer requirements and provide reference numbers for tracking.
What if a denial is provider-dependent?
We’ll coordinate with your team for any missing documents, signatures, or clinical notes.
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