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Denial Management

We proactively manage denied claims by tracking, categorizing, and appealing them efficiently to minimize revenue loss and improve clean claim rates over time. Our approach focuses on resolving current issues and preventing future denials.

Root Cause Analysis: We identify and analyze common denial patterns to address underlying issues such as coding errors, eligibility gaps, or authorization problems.

Standardized Appeals Process: Our team uses well-crafted, payer-specific appeal templates, supported by thorough documentation, to maximize overturn success rates.

Payer Policy Monitoring: We stay current with evolving payer guidelines and policy changes to ensure ongoing compliance and reduce preventable denials.

Planning and sketching

Modern and unique design practically point of view, it risks not meeting the huge expectations

Team working

Modern and unique design practically point of view, it risks not meeting the huge expectations

Flowchart and wireframe

Modern and unique design practically point of view, it risks not meeting the huge expectations

User experience Testing

Modern and unique design practically point of view, it risks not meeting the huge expectations

ACA Commercial Risk Adjustment Coding

We support accurate and compliant risk adjustment coding for Affordable Care Act (ACA) exchange-based plans by capturing all eligible diagnoses that impact a member’s Risk Adjustment Factor (RAF) score. Our certified coders conduct thorough medical record reviews and detailed abstraction to identify and document all relevant chronic and high-impact conditions. By aligning with HHS-HCC risk models and payer-specific requirements, we help health plans enhance RAF scores, ensure appropriate premium transfers, and maintain compliance with regulatory standards—ultimately supporting both financial performance and care quality.