The denials your process closed out are still worth money.
We rework denied and underpaid claims after your team has moved on, and we tell you what caused them so fewer come back.
Denials are common, and most are left on the table.
Figures are from Mantl Health client engagements and will vary by specialty and payer mix.
Find the cause. Fix it or appeal it. Tell you why.
Find the real cause
The reason code on the remittance is a starting point. We read the claim, the record, and the payer's policy to find what actually went wrong: eligibility, authorization, coding, documentation or timing.
Correct and resubmit, or appeal
If the claim was wrong, we correct it. If the payer was wrong, we appeal with the records attached, to the right address or portal, inside the deadline. We track every deadline so none lapses.
Review the coding before anything goes back out
A "not medically necessary" denial is often a coding or documentation gap rather than a payer being wrong. Our coding team reads the claim against the record and the payer's policy, corrects what should be corrected, and lets go of what should not have been billed, so what we do send back is a claim the payer has no reason to deny again.
Feed it back
Each month you get a one-page summary of denial causes by payer, and changes at registration or coding that would have prevented the denial in the first place.
What we do about each, and what you can fix upstream.
| Cause | What we do | What your front end can change |
|---|---|---|
| Coverage not active or not found | Search for other coverage. Rebill the right payer. Ask the patient. | Verify eligibility at scheduling and again on the day. |
| Authorization missing | Request retroactive authorization where the payer allows. Appeal with clinical records. | Tie authorization checks to the order, not the visit. |
| Not medically necessary | Appeal with the record and the payer's own policy. Prepare a patient appeal where that is stronger. | Document the indication the policy asks for. |
| Coding or modifier | Correct and resubmit. | Share the pattern with your coders monthly. |
| Coordination of benefits | Call the patient to confirm which plan is primary. Rebill in order. | Ask about other coverage at every registration. |
| Filed too late | Appeal with proof of timely submission where it exists. | Watch the oldest unbilled accounts weekly. |
Insurers answer to their members.
A provider's appeal is a contract dispute between two businesses. A member's appeal is a customer exercising rights under their own plan, and in many cases under federal and state law, including review by an independent third party.
Most patients don't know they have that right, and almost none know how to use it. When a patient disputes a bill that an insurer should have paid, we ask whether they would be willing to appeal to their plan. If they are, we write the appeal narrative and give them step-by-step instructions: which records to attach, where to send it, and the deadline. The patient submits it themselves, as their own appeal. It costs them nothing, and when it succeeds their balance usually falls too.
Why patient appeals win when provider appeals don't →- Authorization missing, 41 claims, mostly one imaging payer
- Coverage not active, 28 claims, 19 had other coverage
- Coordination of benefits, 17 claims, resolved by patient call
- Medical necessity, 9 claims, 6 on appeal
What to change: check authorization when imaging is ordered; ask about a second plan at registration.
Other late-stage work we take on.
Underpayment and zero-balance review
We compare what was paid against your contracts on accounts already closed, and pursue what was short-paid.
Legacy AR workdown
When you change EMR systems, the old system's receivables tend to be forgotten. We work them down while your team learns the new one.
Third-party liability and workers' compensation
Auto, liability, and work-injury claims have their own rules and long timelines. We handle them without heavy legal fees.
Credit balances
Overpayments owed back to patients and payers are a compliance risk. We identify and resolve them so they stop accumulating.
Insurance recovery, asked plainly.
Our billing company already works denials. Why add you?
Because every team has a point where it stops. We start there. In most engagements about half of the denied claims we receive were resubmitted at least once without the cause being fixed.
How old can a claim be?
It depends on the payer's appeal window and your contract. Send us the inventory and we will tell you which claims are still within reach before you commit to anything.
Do patients have to do anything?
Only for a patient appeal, and only if they choose to. We write the appeal narrative and the instructions; the patient attaches the records and sends it. Many are glad to, since a successful appeal usually lowers what they owe.
What do you need from us?
Read-only access to claims and remittance data, your payer contracts for underpayment review, and thirty minutes a month.
