Services
The claims we work.
Medicare Advantage denials and underpayments for independent practices, each sent down the path the plan actually reviews.
The denials we work
Your path depends on your contract with the plan: out-of-network claims go to reconsideration (65 days from the denial notice), in-network claims go through the plan's provider dispute process.
No prior authorization
Retro-authorization requests, then a reconsideration or dispute built on the plan's own criteria.
Not medically necessary
Appeals that match your documentation to the plan's coverage policy.
Missing information
Corrected claims resubmitted cleanly and tracked to payment.
Timely filing
Reconsiderations or disputes with proof the claim went out on time.
Paid below contract or Medicare rates
Reopening requests for pricing and clerical errors, within one year of payment (four with good cause). A reopening isn't an appeal, so it has to be right the first time.
Is a plan leaving your area in 2027?
Several large insurers are cutting Medicare Advantage plans and counties for 2027. If one of your plans is leaving, work its open denials and underpayments now, while the plan is still staffed to answer them.
What we need from you
Only after a Business Associate Agreement is signed:
- Denial letters and remittances for the claims you choose
- Your contract or fee schedule with each plan, for underpayments
- Records the appeal needs, and nothing more
- Portal or system access if you prefer we work inside your systems
Medicare Advantage is our focus. Ask about commercial and Medicaid claims; we'll tell you plainly if they're a fit.
Not sure which path a denial takes?
Start with the free toolkit, or call and walk through one example, with no patient details.