No billing department. No dedicated denial team. Just a solo consultant with the analytical infrastructure of a health system — applied to your remittances.
The starting point for every engagement — and it costs you nothing.
We analyze 90 days of your remittance files, identify your specific denial patterns by payer and reason code, and deliver a full findings report within 30 days. No obligation. No commitment. The analysis is yours regardless of whether you continue.
What you provide: 835 EDI files or PDF EOBs from your clearinghouse (Availity, Waystar, or payer portals). Usually a single export. A signed Business Associate Agreement is required before files are shared.
Systematic identification and appeal of your highest-value recoverable denials.
Monthly remittance analysis, priority queue management, and appeal letter generation for your open denied claims. We classify every denial by category, estimate win probability, and generate tailored appeal letters — not generic templates, but letters citing your specific CARC code, the relevant clinical guidelines, and the applicable payer policy.
The denial category where delay means permanent loss.
Every payer has a different timely filing window — UnitedHealthcare at 90 days is the tightest in the commercial market. A CO-29 timely filing denial on a claim you simply forgot to track is revenue you can never recover. We surface every at-risk claim before the window closes.
Visibility into whether your denial rate is improving over time.
Monthly summary report showing denial volume, dollar value, top codes, payer performance, and recovery activity. Track which payers are improving, which denial categories are recurring, and whether your win rate is trending in the right direction. Actionable data, not dashboards for their own sake.
Denial benchmarks and recovery estimates calibrated to your specialty — not generic averages.
Our benchmark engine automatically detects your practice specialty from your CPT code distribution and applies specialty-appropriate win rates from 7 years of real physician ERA data. An orthopedic practice gets orthopedic benchmarks. A GI practice gets GI benchmarks. The recovery estimates in your report reflect what practices like yours actually recover — not a blended average across all specialties.
Find out if your payers are actually paying what your contracts say they should.
Most independent practices negotiate a contract, file it away, and never verify whether payer remittances actually match contracted rates. Contract underpayments are silent — they don't generate a denial code, don't appear in your AR, and never get worked. They just quietly reduce your revenue on every claim, every month, indefinitely.
We compare your actual received payments against your contracted fee schedules and CMS benchmark rates for your state, identifying every procedure where you're being systematically underpaid. For practices in states with commercial rates near Medicare floor — particularly in the South and Midwest — this is often as significant as denial recovery.
What you provide: Your current payer contracts or fee schedules, plus 90 days of remittance data. Available as a standalone engagement or as an add-on to denial recovery.