Astral Medical Services

Denial Management Services for Medical Practices

We recover lost revenue from denied claims and put processes in place so the same errors stop happening.

HIPAA-Compliant
U.S.-Based Experts
Free Practice Audit

Revenue Recovery

Why Denied Claims Are Costing Your Practice More Than You Think

Most practices get a denial, write it off, and move on. That's money left on the table every single month. Studies show that nearly 90 percent of claim denials are preventable, and up to 67 percent of denied claims are recoverable if someone actually follows up on them.

The problem is that following up takes time your billing staff usually doesn't have. Claims sit in a queue, deadlines pass, and what started as a fixable denial becomes unrecoverable revenue.

At Astral Medical Billing, we handle the entire denial management process for you. We identify why claims are getting denied, fix the root cause, appeal the ones that can be recovered, and put processes in place so the same errors stop happening.

Our Medical Billing Denial Management Process

Step 1: Denial Categorization

Not every denial is the same. We sort denials by type, whether that is a soft denial that just needs a correction or a hard denial that requires a formal appeal, so we know exactly what each claim needs to move forward.

Step 2: Root Cause Analysis

We dig into why each denial happened. Coding errors, missing modifiers, eligibility issues, timely filing problems. We identify the exact reason before we do anything else. Fixing the symptom without finding the cause just means the same denial shows up again next month.

Step 3: Correction and Resubmission

Once we know what went wrong, we fix it. Missing information gets added, coding errors get corrected, modifiers get updated, and the claim goes back out clean.

Step 4: Appeals for Medical Necessity Denials

When a payer denies a claim on medical necessity grounds, we build a proper appeal. That means pulling the clinical notes, writing a strong appeal letter, and submitting it within the payer's deadline.

Step 5: Prevention Going Forward

After we recover your denied claims, we report back on the patterns we found. If the same coding error is showing up repeatedly, or a specific payer keeps denying a certain procedure, we update your front-end processes to stop it from happening again.

These are the denials we see and recover most often. Timely filing exceeded is included because many of these are still recoverable with the right documentation, so we appeal them too.

Common Denial Reasons We Fix

Eligibility expired or patient not covered at the time of service
Duplicate claim submissions
Missing or incorrect modifiers

Medical necessity denials where prior authorization was not obtained
Bundling issues where procedures are incorrectly combined
Timely filing exceeded, which we still appeal because many are recoverable

Look Up a Denial Code

Plain-English guides to the codes on your remittances: what each one means, whether it's fightable, and how to fix it.

Complete Denial Codes List (CARC/RARC)CO 45: Charge Exceeds Fee Schedule CO 16: Claim Lacks Information CO 253: Medicare Sequestration PR 119: Benefit Maximum Reached CO 236: Incompatible Procedure Combination

Support

Frequently Asked Questions About Denial Management Services

Denial management is the process of reviewing claims that insurers have rejected, finding out why they were denied, correcting the issues, and resubmitting or appealing them to recover payment. It also includes identifying patterns in your denials so the same errors stop repeating.

It depends on your current denial rate and how long claims have been sitting. Most practices we work with see meaningful recovery within the first 60 days as we clear the backlog and start working through aged claims.

A soft denial is temporary and can be fixed by correcting or adding information before resubmitting. A hard denial means the payer has made a final decision and the only path to payment is a formal appeal. We handle both.

Yes. Timely filing denials are not always final. If you have documentation showing the claim was submitted on time or there were extenuating circumstances, we build that case and appeal it.

Yes. We work inside your current system and do not require you to change anything. We have experience with Epic, eClinicalWorks, Kareo, AdvancedMD, and most other major platforms.

You get a monthly report showing every denied claim, what action was taken, and the outcome. Nothing falls through the cracks without you knowing about it.