Denial management and AR recovery answer different questions
Denial management asks why a payer refused a claim and what will reverse the decision. AR recovery asks which claims are still unpaid and who is working each one. A practice can have a tidy denial process and still carry a large 90-day balance, since claims that were never denied can sit unpaid too.
Claimstone runs both from one worklist, so a pattern found on one claim gets checked across every open claim from that payer.
Denial management
Reading the remittance, coding the reason and choosing the fix: a corrected claim, an appeal, or a write-off request for your approval.
AR recovery
Working every unpaid claim by age group, from the first 30 days to beyond 120, until payment posts or your practice signs off on a close.
Eight tasks we take off your billing desk
Denial follow-up slips whenever the front desk gets busy. Each task below moves to a team that handles it daily, phone calls included.
Denial categorization
Every denial is tagged by reason code, payer, provider and CPT code, so repeat causes appear in a report instead of in someone's memory.
Claim correction
Modifier, diagnosis and payer ID errors are fixed, then the claim is presented with the right frequency code to avoid a duplicate denial.
Appeal preparation
Letters cite the payer's policy and your contract, with chart notes attached and a summary for your physician to sign.
Aged claim follow-up
Open claims are worked by age group, from 0 to 30 days up to over 120. Every payer call and portal check is logged.
Underpayment recovery
Payments are compared against your contracted rates. Anything paid short goes back to the payer with the contract line and the shortfall.
Deadline tracking
Filing limits and appeal windows are logged per payer. Medicare fee-for-service allows 120 days for a first appeal.
Payer escalation
When a first appeal fails or a payer goes quiet, we move to second-level appeals, provider representative contacts and peer-to-peer reviews with your physician.
Write-off review
Unrecoverable balances are listed with the reason and sent to you. Nothing is adjusted off without your sign-off.
Six reasons denied claims stay unpaid, and how we respond to each
Denials worked in arrival order
Small denials get cleared first because they are easy, while a large claim waits until its appeal window closes.
Worklists are ranked by dollar value and days left to appeal, so large claims with short windows open first.
Repeat denials
A payer edit rejects one modifier pairing and the same error ships again next week.
Each repeating code is traced to registration, coding or a payer edit and sent to its owner.
Late or thin appeals
An appeal leaves the office with no chart notes and one day left, and the payer upholds the denial.
Appeal windows go on a calendar the day the remittance posts, and records are requested before drafting starts.
Aged claims with no owner
Claims over 90 days sit unworked because no one owns the calls.
Every open claim carries a named owner, a next contact and a log of what the payer said last.
Underpayments posted as paid
The claim leaves the worklist even though the payer paid less than the contract rate.
Payments are checked against your fee schedule at posting, and shortfalls reopen as new items.
Rejections mistaken for silence
A clearinghouse rejection never reaches the payer, yet the practice waits for payment.
Rejection reports are read daily, and rejected claims are corrected and resent before they age into the AR report.
Seven steps that carry a denied claim to a recovered payment
Every step leaves a note on the claim: what was found, what was sent, who replied.
Remittance intake
ERAs, denial letters and aging reports are pulled from your system and payer portals into one worklist.
Denial coding
Each denial is matched to its adjustment code and sorted by cause: registration, authorization, coding, medical necessity or payer error.
Value and deadline ranking
Items are ranked by amount, days left to appeal and likelihood of reversal.
Correction or appeal
Fixable errors go back as corrected claims. Disputed decisions get an appeal packet.
Submission
Sent through the channel each payer requires (portal, fax or mail), with confirmation stored on the claim.
Follow-up & escalation
Contact on a set cadence per payer. Upheld or silent items move to second-level appeals or a peer-to-peer review.
Posting & feedback
Recovered payments are posted and reconciled against the expected amount, and root causes go to your team.
Every denied claim has an owner and a deadline until it resolves
Payers decide how an appeal ends. A billing partner controls how fast a denial is read, how complete the appeal is and how often the payer is contacted.
Deadline-first worklists
Items sorted by days left to appeal, so nothing expires while a smaller claim gets attention.
Reason-level reporting
Denials are counted by code, payer and provider, so you can see which single cause costs the most.
Evidence in every appeal
Each appeal cites the payer's published policy, your contract and the chart notes that support the service.
Payer-specific handling
Filing addresses, forms and portal steps are kept per payer and rechecked, since they change.
Fixes at the source
Recurring causes go back to registration, coding or charge entry with examples, so the error stops repeating.
Many denials start long before the remittance arrives
In Experian Health's latest State of Claims survey, providers most often named missing or inaccurate data (50%), authorizations (35%) and registration errors (32%) as denial causes.
Registration
Coverage confirmed
Authorization
Approval on file
Coding
Codes match the chart
Claim submission
Accepted by the payer
Denial management
Reason coded, appeal filed
AR recovery
Paid or closed
What changes when denial work has a dedicated team
Fewer missed windows
Appeal deadlines are tracked from the first remittance, so recoverable claims are not lost to a lapse.
Front office time back
Payer calls, portal checks and appeal letters move off your staff's list and onto ours.
Usable denial data
Reports split denials by code, payer and provider, so a training fix has a clear target.
Steadier AR
Balances past 90 days get scheduled contact instead of waiting for a slow week.
Cover for turnover
Worklist, notes and payer history stay with the claim, so a resignation does not restart the follow-up.
From a single provider to a multi-site group
Small practices
One biller handles claims, calls and posting, so denials wait their turn.
Multi-site groups
Contract terms and payer behavior vary by site, so denial patterns need side-by-side reporting.
Backlog cleanups
A stack of 90-plus day claims and no spare hours to work them.
In-house billing teams
Staff keep submitting and posting while we carry the denial and appeal load.
High-denial specialties
Services with prior authorization, medical necessity edits or modifier scrutiny.
Specialties we see most often
Denial patterns shift by specialty. These are the ones we handle regularly.
A question about one claim should take a single lookup
Each denied or aging claim carries the same set of fields. The sample below shows the columns your practice sees.
Denial and AR questions we hear most
Not covered here? Ask our team and we will reply with your payer mix in mind.
What is denial management?+
It is the work of finding out why a payer refused a claim, choosing the right fix, and carrying it to payment. That means reading remittance codes, correcting errors, filing appeals with records, and reporting patterns so the same denial stops recurring.
How is a rejection different from a denial?+
A rejected claim failed front-end edits and was never processed, so it can usually be fixed and resent. A denied claim was processed and refused, and needs a corrected claim or an appeal.
How long do we have to appeal?+
It depends on the payer and the contract. Medicare fee-for-service allows 120 days from receipt of the initial determination for a first appeal, and some commercial contracts close sooner. We log the window for each payer when the denial posts.
Can you work on old, aged claims?+
Often, as long as the payer's filing and appeal limits have not passed. Those limits differ by payer, and Medicare requires a claim to be filed within 12 months of the service. We sort the backlog by age, value and time left, and start with claims that can still be recovered.
Which denials are worth appealing?+
It depends on the amount, the denial reason and how that payer has handled similar claims. Some denials are corrected and resent. Others cost more to fight than they return, and those go to you as write-off requests.
What do you need from us to get started?+
Typically an AR aging report, recent remittances, denial letters, payer contracts or fee schedules if you have them, and access to payer portals and your billing system. Chart notes are requested claim by claim, only when an appeal needs them.
Do we need new software?+
No. Claimstone works inside the practice management system and clearinghouse you already use and posts recovered payments there. If your staff also bills in-house, we coordinate so no claim is worked twice.
Will this lower our denial rate?+
It can, over time. Every denial is coded to a cause, and recurring causes go back to your registration and billing staff with examples. We do not guarantee a specific drop, since payer edits and your intake process both play a part.
Find out what is recoverable
Send your AR aging report and top denial reasons. We will review where balances stand, flag what is near a deadline, and outline the work each group of claims needs.
