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DENIAL MANAGEMENT SERVICES

Denial Management Services Focused on Root Cause, Not Resubmission

Working one denial fixes one claim. Finding the pattern behind it stops the next ten from happening the same way.

We call it RAPID: review, action, prevention, insight, delivery. Five stages, same order, every time, whether it's one denied claim or a pattern across your whole payer mix.

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99%

Clean Claim Rate

12–24

Hour Entry Turnaround

900+

Payers in Network

50

States Served

THE RAPID PROCESS

How MedSole's Denial Management Services Run on RAPID

RAPID stands for review, action, prevention, insight, and delivery. Each stage produces something the next one needs, so nothing gets skipped and nothing depends on someone remembering to follow up.

Review

Every denied claim gets categorized by type: hard, soft, clinical, technical, coding, or authorization. We pull the CARC and RARC codes and identify where the breakdown happened, a registration error, a coding mistake, a documentation gap, or a payer policy issue.

Action

Soft denials get corrected and resubmitted. Hard denials go through a payer-specific appeal package with supporting clinical documentation and policy references. Complex medical necessity cases get a peer-to-peer review with the payer's medical director.

Prevention

The cause feeds back to the team that can stop it from happening again: front desk, coders, or documentation staff. Workflows get updated and claim edits get configured based on what the pattern shows.

Insight

You see denial rate by payer, denial dollars by category, and appeal success rates, tracked and reported so you know where the problem sits, not that a problem exists.

Delivery

Every case closes out with the claim paid, the denial written off with your sign-off, or escalated further. Nothing stays open and unresolved.

Ready to see what your denials are costing you?Start with a free denial review.?

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DENIAL TYPES WE RESOLVE

The Six Denial Types Our Denial Management Services Resolve

Not every denial fails for the same reason, and not every fix looks the same.

Hard Denials

Permanent rejections that can't be resubmitted: services not covered under the plan, or procedures billed outside what's allowed. We flag the pattern so it doesn't repeat, and advise on the patient billing path when a hard denial can't be reversed.

Soft Denials

Temporary rejections from correctable errors: wrong patient information, missing documentation, or a coding mismatch. We fix the error, attach what's missing, and resubmit.

Clinical Denials

These challenge medical necessity or level of care, and they need clinical documentation, not a resubmission alone. We build the appeal around evidence that holds up under review.

Technical Denials

Administrative errors: an invalid CPT code, a wrong modifier, missing prior authorization, a timely filing miss. Claim scrubbing catches most of these before submission. For ones already denied, we correct and resubmit with the right documentation.

Coding Denials

ICD-10, CPT, or HCPCS errors, bundling issues, or a diagnosis code that doesn't support the procedure billed. Certified coders review the claim, find the deficiency, and correct it to what the payer requires.

Authorization Denials

The service needed prior authorization and either didn't have it, or the authorization expired before the visit. We track authorization status where possible, and handle retroactive requests for claims already denied.

WHY CHOOSE MEDSOLE

Why Practices Choose MedSole for Denial Management Services

Every denial gets worked the same way, reviewed for cause, corrected, and fed back into how your practice bills going forward.

Fee Transparency

Pricing is stated up front, not buried behind a "contact us for a quote" wall. You see the actual number before you decide anything.

Root-Cause Depth

Every denial gets a documented root cause, not a corrected resubmission alone. That cause feeds back into your workflow so the same denial has a lower chance of returning.

Works Alongside Your Team

This adds a dedicated denial function. It doesn't ask you to replace who already handles your billing. Your team keeps working claims, we work denials, and feed what we find back to them.

Built for Your Setting

A solo practice, a specialty clinic, and a hospital don't see the same denial patterns. RAPID runs the same five stages regardless, but what triggers each stage looks different depending on where you practice.

Real Reporting, Not a Spreadsheet

Denial rate by payer, denial dollars by category, and appeal outcomes, tracked and reported on a schedule, not updated whenever someone finds time.

Every one of these is how MedSole runs denial management, day to day, not a list of features that sound good in a pitch.

99% Clean Claim Rate
900 Payers in Network
Providers Served
Specialties Covered
of Collections
HOW PRACTICES ENGAGE MEDSOLE

Two Ways to Handle Denial Management

Denial management services work as a standalone offering, or included at no extra cost inside full-service RCM.

Standalone Denial Management

4.49% of what gets recovered
  • Covers RAPID review, action, and appeal preparation
  • Root-cause reporting included, not a paid add-on
  • No setup fee
  • Cancel anytime
  • Works alongside your existing billing team
  • Covers all six denial types, hard through authorization
Start Denial Management at 4.49%
Best Value

Included Free Inside Full-Service RCM

FREE / Included in your 2.99% rate
  • No separate denial management charge inside full RCM
  • Included at the 2.99% collections rate
  • Covers claims submission, coding, and prior authorization too
  • All 8 RCM stages covered, registration through reporting
  • Root-cause analysis included, not an extra line item
  • One team handles your whole revenue cycle
See What's Included in Full RCM
Transparent pricing. No hidden fees. No surprises.
WHAT PRACTICES ASK

Questions Practices Ask About Denial Management Services

Everything you need to know about pricing, root cause, and how this fits with what your team already does.

Still have questions?

Can't find the answer you're looking for? Our denial specialists can walk you through your specific denial patterns.

Q1 How much do denial management services cost if I don't need full RCM?

Standalone denial management runs 4.49% of what gets recovered. For practices running full-service RCM with MedSole, it's included at no separate charge inside the 2.99% of collections rate.

Q2 What's the difference between denial management software and tracking denials by hand?

Software flags that a claim was denied. It doesn't tell you why, correct the error, or feed that reason back into your workflow. RAPID does all three.

Q3 Are denial management services different for hospitals versus clinics?

Yes. A hospital's denial mix, DRG downgrades, high-dollar clinical reviews, looks nothing like a solo practice's. RAPID runs the same five stages either way, but what triggers each stage is built around your setting.

Q4 Can this work alongside our existing in-house billing team?

Yes. This adds a dedicated denial function. It doesn't replace your billing team. They keep working claims, we work denials, and the two connect through what we find.

Q5 Is this HIPAA compliant?

Yes. We sign a Business Associate Agreement before any data access, and every claim moves through HIPAA-compliant channels.

Q6 Can this work inside my existing EHR?

Yes. We work inside the EHR or practice management system your practice already uses, with no data migration required.