Claims Denials, Rejections & Appeals Services
Comprehensive denials, rejections, and appeals management to recover lost revenue and improve revenue cycle performance.
PlusMed Solutions provides comprehensive Claims Denials, Rejections, and Appeals Management Services to help healthcare providers recover lost revenue, reduce denials, and improve their revenue cycle performance. Our team proactively identifies and resolves claim issues, ensuring timely reimbursement and minimizing financial risk.
What Are Claim Denials and Rejections?
Claim Denials occur when an insurance payer refuses to pay a submitted claim due to eligibility issues, medical necessity, coding errors, or missing documentation. Claim Rejections are claims that are returned without processing due to errors in submission, incorrect codes, or incomplete information. Without effective denial and rejection management, healthcare providers can experience delayed payments, lost revenue, and increased administrative burden.
Comprehensive Denial and Rejection Management Services
Denial Identification & Categorization
We systematically review all denied or rejected claims to identify root cause of denial or rejection, payer-specific trends and patterns, and claim type, specialty, or service-related issues. This allows us to prioritize high-value claims and prevent recurring denials.
Error Correction & Claim Resubmission
Our team corrects errors in patient demographics and insurance details, CPT, HCPCS, and ICD-10 coding, modifiers and billing units, and documentation and prior authorizations. Corrected claims are resubmitted promptly to ensure faster payment.
Appeals Management
For claims that remain denied after initial resubmission, we manage the full appeals process, including gathering necessary clinical documentation, preparing appeal letters and supporting evidence, submitting appeals to payers in a timely manner, and communicating with payers to resolve issues. Our goal is to maximize recoverable revenue while minimizing delays.
Proactive Payer Communication
We handle all communications with insurance payers to clarify reasons for denials, resolve underpayments or partial payments, and expedite pending claims and appeals. This proactive approach prevents long-term revenue loss and improves payer relationships.
Reporting & Analysis
PlusMed Solutions provides detailed reporting and analysis to track denial and rejection trends, measure appeal success rates, identify areas for process improvement, and reduce future claim denials.
Key Benefits
Specialties We Support
- Primary Care and Internal Medicine
- Cardiology
- Orthopedics
- Radiology & Diagnostic Imaging
- Mental Health and Behavioral Health
- Urgent Care
- Physical Therapy and Rehabilitation
- Specialty and Surgical Practices
Why Choose PlusMed Solutions
- Experienced team specializing in denials, rejections, and appeals
- Expertise across Medicare, Medicaid, and commercial payers
- HIPAA-compliant and secure processes
- Scalable solutions for practices of all sizes
- Transparent reporting and proactive follow-up
Get Started Today
With PlusMed Solutions' Claims Denials, Rejections, and Appeals services, healthcare providers can confidently recover lost revenue, reduce delays, and improve their overall revenue cycle—allowing them to focus on delivering quality patient care.
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