Denial Management

Stop Losing Revenue to Preventable Claim Denials.

A denied claim doesn’t have to become lost revenue. But when denials are left unresolved, they can quickly increase A/R, delay payments, create additional administrative work, and put unnecessary pressure on your billing team. DuoSol’s Denial Management services help healthcare organizations identify why claims are being denied, take appropriate corrective action, and develop processes to reduce recurring denial problems.

Every Denial Has a Reason. We Help Find It.

Turn Denials Into Actionable Opportunities

A denial is more than a claim that wasn’t paid. It can be a sign of an eligibility issue, authorization problem, coding error, documentation gap, payer rule, timely filing concern, or another breakdown somewhere in the revenue cycle. If the same denial keeps happening, simply resubmitting the claim isn’t enough.

DuoSol takes a structured approach to denial management. We review the denial reason, determine what went wrong, identify the appropriate next step, and track the account through resolution.

Identify Denial Causes

We analyze denial information to understand why claims are being rejected or denied.

Work Denied Claims

We help correct and address denied claims according to the circumstances and applicable payer requirements.

Appeal When Appropriate

When a denial may be appealable, we help coordinate the information and documentation needed for the appropriate appeal process.

Prevent Recurring Denials

We analyze denial patterns to identify problems that may be occurring earlier in the revenue cycle.

What We Handle

Complete Denial Management Support

DuoSol helps healthcare organizations manage denied and rejected claims from initial review through appropriate resolution and reporting.

Denial Identification

We identify denied claims and organize them by payer, denial reason, provider, specialty, age, balance, and other relevant factors.

Denial Categorization

Understanding the type of denial is important. We categorize denials to help determine the appropriate action.

Root Cause Analysis

We look beyond the denial code to understand what caused the claim to be denied and where the problem originated.

Eligibility Denials

We review denials related to coverage, eligibility, member information, insurance status, and other front-end issues.

Authorization Denials

We review denials associated with prior authorization, referrals, or payer approval requirements.

Coding & Billing Denials

We help identify claims affected by coding, billing, modifier, or claim-information issues and determine the appropriate corrective action.

Documentation-Related Denials

We help identify cases where additional documentation or information may be required for claim processing.

Timely Filing Denials

We review timely filing-related denials and identify whether any appropriate options remain based on the payer's requirements and available information.

Appeal Support

For denials that may be appealable, we help organize relevant information and support the appropriate appeal workflow.

Our Denial Management Process

From Denial to Resolution

Effective denial management requires more than submitting an appeal and hoping for a response. Every denial should be reviewed, categorized, worked, documented, and monitored.

01

Identify the Denial

We collect and review denied and rejected claim information from the available billing and payer systems.

02

Categorize the Issue

We determine the type and reason for the denial to help establish the appropriate workflow.

03

Investigate the Root Cause

We review available claim, patient, insurance, coding, authorization, and documentation information to understand what caused the denial.

04

Determine the Next Action

Depending on the circumstances, the appropriate action may include correction, resubmission, additional documentation, payer follow-up, or appeal.

05

Submit & Follow Up

We help move the claim through the appropriate resolution process and follow up with the payer when necessary.

06

Track the Outcome

We monitor the account until the next appropriate resolution point and document the outcome.

Why DuoSol?

We Don't Just Work Denials. We Look for the Pattern Behind Them.

Anyone can work a denial. The real value comes from understanding why it happened and what can be done to prevent it from happening again. DuoSol combines claim-level follow-up with broader revenue cycle analysis.

Root-Cause Focused

We look beyond the denial message to understand the underlying issue.

Prioritized Workflows

High-value, time-sensitive, and strategically important accounts can receive appropriate priority.

Detailed Follow-Up

Denied claims require persistence and documentation. We maintain visibility into actions and outcomes.

Payer Awareness

Different payers can have different requirements and processes. We work according to the applicable payer workflow.

Revenue Cycle Perspective

Denials can originate from eligibility, credentialing, authorization, coding, documentation, claims processing, and other areas. We consider the entire revenue cycle.

Frequently Asked Questions

Answers to Common Questions

Everything you need to know about working with DuoSol. Still have questions? Book a consultation and we’ll walk you through it.

What is Denial Management?

Denial Management is the process of identifying, analyzing, correcting, following up on, and resolving healthcare claim denials while also identifying opportunities to prevent recurring denial problems.

Why do medical claims get denied?

Claims can be denied for many reasons, including eligibility issues, authorization requirements, coding errors, missing documentation, payer rules, timely filing issues, incorrect information, and other claim-processing problems.

Do you work on old denied claims?

Yes. We can review aging denied claims and prioritize them based on factors such as balance, age, payer, denial reason, and potential recovery opportunity.

Can you appeal denied claims?

When a denial appears appealable, we can support the appropriate appeal workflow by helping organize relevant claim information and documentation according to your organization’s process and payer requirements.

Can you correct and resubmit denied claims?

When appropriate, we can help identify the issue requiring correction and support the claim correction and resubmission process.

Do you handle insurance denials?

Yes. Insurance claim denials are a core part of our denial management support.

Ready to Take Control of Your Denials?

Let's Turn Denials Into Opportunities for Improvement.

Every unresolved denial represents more than an unpaid claim. It represents time, administrative work, and revenue that your organization may be waiting to recover. DuoSol helps healthcare organizations understand their denials, work appropriate recovery opportunities, identify recurring problems, and strengthen the processes that can prevent avoidable denials. Let’s review your denial history and find opportunities to improve your revenue cycle.