Our denial management services help Wisconsin healthcare providers resolve claim denials, recover eligible revenue, and prevent recurring billing errors while maintaining payer compliance.
When dealing with denied claims it is important to ensure you’re following up claims in a timely manner. We’ll check claims that have been denied, investigate why they were denied and what should be done to resolve them.
We will help your healthcare provider in Wisconsin put right billing mistakes, pursue revenue that is due to you and reduce reoccurring denials.
We will look into denial codes, remittance advice and claim statuses to identify what caused the denial, priorities unpaid claims and find out what needs to be done to fix them.
We’ll fix any billing mistakes, create appeals with evidence and monitor resubmitted claims to help you get the revenue that is due to you.
We’ll investigate why there are reoccurring denials related to eligibility, coding, documentation and authorizations and recommend ways to improve this.
We’ll investigate unpaid claims, monitor outstanding amounts and priorities accounts based on any deadlines.
We identify coding discrepancies and documentation gaps, helping ensure claims accurately reflect clinical records and meet applicable payer requirements.
We track denial trends, outstanding claims, and resolution progress to help providers identify reimbursement issues and improve revenue cycle performance.
We’ll investigate why claims have been denied and what needs to be fixed or evidence provided to get claims that are due paid.
We’ll monitor claims that haven’t been resolved and ensure you’re aware of any deadlines from your payers to reduce delays.
We’ll take into consideration any requirements from Forward Health, Badger Care Plus and Commercial payers.
By monitoring denied claims and providing reports you’ll be able to see any reoccurring issues.
Insurance claim adjustment and denial codes help providers understand why a payer reduced or denied payment. Our team reviews applicable codes and payer explanations to identify corrective actions, documentation requirements, and appeal opportunities.
| Code | Meaning | Recommended action |
|---|---|---|
| CO-16 | Claim lacks information or contains billing errors | Review missing information and correct the claim |
| CO-18 | Duplicate claim or service | Verify previous submissions and claim status |
| CO-29 | Filing deadline has expired | Review submission dates and applicable exceptions |
| CO-50 | Service not considered medically necessary | Review clinical documentation and payer policy |
| CO-197 | Required authorization or precertification is missing | Verify authorization records and appeal eligibility |
We will investigate the denied claims, what the payer has said and any outstanding accounts.
We’ll categories the denial by reason, payer and priority to see what needs to be worked on.
Where applicable we’ll fix any billing mistakes. We’ll then either resubmit or appeal with evidence.
We’ll track the progress of your claims, respond to any queries from the payer and if applicable ask for them to look into your claim further.
We’ll look into any reoccurring issues and recommend ways to improve in the future.
Identify claims that can be recovered, fix billing mistakes and appeal to help you get the revenue that is due.
Identify any reoccurring issues and fix any issues with coding, documentation, eligibility and authorizations.
By consistently following up on denials you’ll prevent claims that are due from being left outstanding.
Outsource any time-consuming tasks such as investigating denials, following up with payers and creating appeals so you can spend more time focusing on your practice.
Use the information from denied claims to improve your checks, evidence and claims.
By monitoring the reasons for denials, outstanding claims, appeals and resolutions you can make smarter decisions regarding your billing.
Denial management services involve identifying, investigating, fixing, appealing and monitoring denied insurance claims. This will help identify any reoccurring issues.
Common reasons for medical claims to be denied often include lack of active insurance, missing information, incorrect coding, authorization issues, lack of evidence, medical necessity and deadlines missed.
Yes, we can look into any existing denied claims, see what status they are currently in and what deadlines apply. We can then decide if we can fix, resubmit or appeal. Whether you can recover depends on the situation and what the payer requires.
We can look into any denial issues relating to Forward Health, Badger Care Plus and other applicable payers.
Contact our team to discuss your denial management needs and discover how we can help improve your claim resolution process.