Denial Analysis

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Denial Analysis

SWAGPRO denial specialists will review the procedure denial, determine whether your denial can be appealed, process all the necessary paperwork required to get the claim paid, and manage the status of your appeal through adjudication which will improve reimbursement chances.

We aggressively follow up on all unpaid or underpaid claims that have gone beyond 25-35 days (the average time for a claim to be paid or denied). Having a professional medical billing company is essential during this period, considering how difficult insurance companies make the appeal process by shortening filing deadlines.

Medical claims can be denied for a variety of reasons, such as:

Insufficient information to process your claim

Human error such as putting the wrong code for the service on your claim

Services received are not covered under your plan

The lifetime maximum limit with your insurance provider is reached

At Swagpro Medical Billing Services, our appeal specialists will determine the cause of denial, process all the paperwork required to get the claim paid, and work diligently to obtain your reimbursement. We will personally contact insurance companies to request for a review of an adverse benefit determination, including the patient’s claim for benefits or provider contract issue.

You can trust Swagpro Medical Billing Services to handle all of your appeals. It should be expected that a qualified medical billing company complete the entire revenue cycle, but that’s not the only reason we do it. We believe that you shouldn’t have to take on the burden of dealing with the inefficiencies of the appeal process that’s our job.

Every appeal is performed on a case-by-case basis. The majority of our appeals are for medical necessity, but every practice has a different history and often, different needs. Therefore, we adapt our appeal process to a flow that fits your case. We save you time by identifying and correcting errors in your insurance documents and calling the insurance companies on your behalf to correct any errors that may occur along the way.

If after an internal appeal, the provider still denies your request for payment of services, we ask for an independent, external review. By having an unbiased third party review the information you provided, we can generally achieve a successful claim denial overturn for reimbursement.

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