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Denials are not final. They are a worklist you are not finishing.

The industry average for appealed denials is under 40 percent. Our recovery rate is above 60 because we appeal with the specific CARC, RARC, and medical necessity logic each payer actually reviews.

60%+ denial recovery rateRoot cause reporting by payerAppeal turnaround under 14 days
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60%+recovery on appealable denials
14 daysaverage appeal turnaround
5%target first-pass denial rate

Why most denials never get worked

Denial worklists are long and boring. Staff prioritize by what is easy to close, not what is worth recovering. The $400 denial with a complex appeal gets buried under 50 small eligibility kickbacks. After 60 days it is gone for good. Multiply that by a year and the loss is real.

The denial categories we actually fix

  • Medical necessity denials (CARC 50, 96)
  • Authorization denials (CARC 197, 198)
  • Coding and modifier denials (CARC 4, 181)
  • Timely filing denials (CARC 29) with filing-window evidence
  • Bundling and NCCI edits (CARC 97)
  • Non-covered service denials (CARC 204)
  • Eligibility and coordination of benefits denials (CARC 22, 27)

Denials are not problems. They are payer offers. Every denial is the payer testing whether you will work it. Most never do.

ASA Management playbook

How we work a denial

Categorize

Every denial gets a CARC and RARC classification and a recoverability score.

Root cause

We identify whether the denial is a one-off or a pattern. Patterns get fixed upstream so they do not repeat.

Appeal

Payer-specific appeal with medical necessity documentation, records, and the specific regulatory or contract citation the payer requires.

Track and report

Every appeal is tracked to resolution. Monthly report shows denial rate by payer, top reasons, and recovery.

Further reading

Where to go next

Pick a thread and keep pulling. Every engagement starts with the piece that has the biggest revenue leak.

ServiceA/R ManagementServiceMedical BillingServiceMedical CodingSpecialtyOphthalmology BillingSpecialtyAnesthesiology BillingSpecialtyAmbulatory Surgery Centers Billing
What is a realistic recovery rate on denials?
60 to 70 percent on appealable denials when worked correctly. The industry average is closer to 35 to 40 percent. The difference is whether the appeal is specific to the payer's actual review criteria.
Can you work denials we already wrote off?
If they are within timely filing, yes. Write-offs that are clinically and contractually appealable can be reopened and appealed.
Do you handle peer-to-peer reviews?
We prepare the clinical summary and coordinate scheduling. The peer-to-peer itself has to be your provider, but we make sure they walk in with the exact documentation and talking points needed.
Start here

See the revenue leak before you sign anything.

A 30-day claim review, written findings, and a number. That is enough to decide.

Request a free audit Call (973) 699-6689
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