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Denials Coding

Our Denials Coding & Resolution services focus on identifying the root causes of claim denials and underpayments, ensuring a thorough approach to revenue recovery. Our experienced team conducts retro-coding audits to review and correct any coding discrepancies or documentation gaps that may have led to denials. By carefully analyzing payer denial codes, payer guidelines, and coding practices, we pinpoint the underlying issues—whether they involve inaccurate coding, missing modifiers, or non-compliant documentation. Additionally, we provide comprehensive support for appeals processes, crafting detailed, well-supported submissions to recover lost revenue and ensure proper reimbursement. Our goal is to streamline your revenue cycle by reducing denial rates, improving payment accuracy, and ultimately enhancing financial performance.

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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.