Denial Management & Appeals
A denial is unpaid work with a deadline attached.
Your team already treated the patient. The payer's decision arrives, and from that day a clock runs on the appeal window. Each payer sets its own deadline, and a denial that sits in a pile for a few weeks can miss it entirely. After that, the treatment you delivered becomes a write-off.
Floss & Finance works every denial as a case with an answer. We find out why the payer said no, fix what caused it, and send the claim back before time runs out.
What happens to each denial
- Denial identification. We pull denials from remittances and payer portals as they arrive, so none of them sit in a queue waiting for someone to notice.
- Denial categorization. Each denial goes into a group, such as eligibility, missing information, coding, frequency limits, or lack of documentation. The group tells us which fix to try first.
- Root-cause analysis. We follow the denial back to where it began: the verification call, the chart note, the code, or the submission itself.
- Claim correction. We correct data errors and attach the X-rays, narratives, or chart notes the payer asked for.
- Resubmission. The corrected claim goes back through the channel that payer accepts, and we log the date.
- Appeal preparation. When a correction cannot resolve a denial, we build the appeal from the clinical record and the payer's own policy language.
- Appeal deadline tracking. Every open appeal carries its filing deadline in our tracking, so nothing lapses quietly.
- Payer follow-up. We contact the payer after each submission and stay on it until the claim reaches an outcome.
- Documentation review. We compare your clinical notes, imaging and narratives against what the payer requires and tell your team where the chart falls short.
- Denial trend reporting. We report which payers, procedures and reasons produce the most denials, so your team can fix the pattern at its source.
Why we look for the cause first
Resubmitting a claim without fixing its cause invites the same denial next month. So we trace each one to its source, whether that source is a verification step, a chart note, a code or a payer rule. Our trend reports then show your team which habit to change. The aim is a shorter denial queue next quarter than this quarter.
How we work with your team
You keep control of clinical decisions and chart notes. We tell you exactly what a payer wants to see, and you supply it. If a chart falls short, we say so plainly and point to the gap.
A denial is a question from the payer. We answer it on time and with the right paperwork.