Denial follow-up and denial management are different jobs. Follow-up means resubmitting or appealing the claim in front of you. Management means asking why that claim was denied, how many others share the cause, and what has to change in the practice so it stops happening.
Revelrex does both. As an add-on to Medical Billing, denials are worked by the same team that submitted the claims, which means the cause is usually obvious to them and the fix reaches the front desk, the provider or the payer setup quickly.
Practices that benefit
- Practices with a denial rate above roughly 5% of claims, or a rate they have never measured.
- Groups where denied claims are written off because nobody has time to appeal.
- Practices with recurring denials for eligibility, authorization, medical necessity or modifiers.
- Anyone already using Revelrex Medical Billing who wants the full cycle covered.
What usually goes wrong
Denials are worked one at a time
Staff fix the claim on the screen and move on. The pattern behind twenty identical denials is never seen.
Appeal deadlines are missed
Payers give 30 to 180 days to appeal. Without a queue with deadlines, claims age out and become write-offs.
Denials caused upstream
Eligibility not verified, authorization not obtained, a referral missing: these denials are decided at check-in, not in billing.
Nobody reports back
The practice never learns that one payer stopped covering a service or that one provider's notes fail medical necessity reviews.
The actual work
Denial identification
Every denial and partial denial from ERAs and EOBs is captured, including zero-pay lines that look like adjustments.
Categorization
Denials are grouped by reason code family (eligibility, authorization, coding, medical necessity, timely filing, duplicate, coordination of benefits) and by preventability.
Root-cause analysis
For each category we find where the denial was created: registration, scheduling, clinical documentation, coding, claim setup or the payer itself.
Correctable denial workflow
Claims that can be fixed (wrong ID, missing modifier, coordination of benefits) are corrected and resubmitted within the payer's window.
Appeals and follow-up
Denials that require an appeal get one, with the records, policy references and letter the payer's process requires. Appeal deadlines are tracked.
Recurring trend identification
Monthly analysis of denials by payer, provider, code and reason shows which few causes produce most of the lost revenue.
Practice-action identification
When the fix belongs to the practice (verify eligibility for a payer, obtain authorization for a procedure, document a requirement), it appears on your action list with examples.
Denial reporting and prevention
Monthly denial report: rate, dollars, recovery, top causes and the prevention steps in progress.
What is included
- Denial capture and categorization for all claims in the billing scope.
- Corrections and resubmissions.
- First and second level appeals with supporting documentation.
- Monthly denial trend report and prevention recommendations.
- Payer policy monitoring for the payers that generate your denials.
Not included
- External or legal disputes with payers.
- Independent medical necessity reviews by clinicians.
- Denials on claims outside the Medical Billing scope (unless a legacy AR scope is added).
- Legal representation in payer disputes and external medical necessity reviews are not included.
What your practice needs to provide
- The start date of service for denial work.
- Access to clinical documentation needed for appeals.
- A practice contact who can act on prevention recommendations at the front desk and with providers.
- Copies of payer contracts and medical policies where the practice holds them.
Step by step
- 1
Capture
Denials are pulled from remittances daily and entered into the denial queue with the payer deadline.
- 2
Categorize
Each denial receives a category and a preventability flag within two business days.
- 3
Resolve
Correctable denials are fixed and resubmitted; appealable denials are appealed with documentation.
- 4
Analyze
Monthly root-cause review identifies the causes that matter most.
- 5
Prevent
Prevention steps are assigned to the practice or to Revelrex and tracked until the denial category shrinks.
What you receive
Denial queue visible in your dashboard with status and deadlines.
Appeal packets and payer responses stored in your Documents area.
Monthly denial report: rate, dollars denied, dollars recovered, top causes.
Prevention checklist specific to your practice and payers.
Add Denials to your Service Cart
A written proposal follows within two business days.
Frequently asked
How is denial management different from denial follow-up?
Follow-up resolves the denial in front of you. Management adds categorization, root-cause analysis and prevention so the volume of denials goes down over time. Revelrex does both.
Can I buy denial management without billing?
It is offered as an add-on to Medical Billing because the two workflows share data and staff. Practices that want a one-time look at their denials can start with the RCM Audit.
Do you guarantee denial recovery?
No. Some denials are correct and some payer decisions cannot be reversed. We guarantee that every denial is categorized, every correctable claim is corrected, every appealable claim is appealed within the deadline, and you receive the analysis.
What denial rate should a practice expect?
Industry surveys commonly cite initial denial rates between 5% and 10%. Well-run practices get below 5%. Your first report establishes your baseline; subsequent reports track the trend.
What do you need from our providers?
Occasionally an addendum or clarification for a medical necessity appeal, and willingness to adjust documentation habits when a pattern is clear.