Services

Denial management that fixes the claim and the cause

Every denial is worked within two business days, appealed with the right documentation, and traced back to the step that caused it so the same denial stops coming back.

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Codes we work every day4 codes

Code	What it means
`CARCCO-197`	Precertification or authorization absent
`CARCCO-50`	Not deemed a medical necessity by the payer
`CARCCO-27`	Expenses incurred after coverage terminated
`CARCCO-18`	Exact duplicate claim or service

CARC = claim adjustment reason code, as printed on your remittance.

A denial is two problems: the claim that needs to be paid, and the step that will cause the next one. Medwiser works both. Our team corrects or appeals each denial quickly, then looks at the pattern behind it.

Each month you see which payers and reasons drive your denials, and what has changed in your workflow to stop them.

What's included

Denial triageEach denial is categorized by its claim adjustment reason code (CARC) and remark code, then routed for correction, appeal or write-off review.
Corrected claimsCoding, eligibility and data errors fixed and resubmitted within two business days of the remit.
Written appealsAppeals drafted with the payer's required forms, medical records and policy citations, tracked to a decision.
Root-cause analysisMonthly denial trends by payer, reason and provider, with the front-desk, coding or authorization step that needs to change.
Payer policy trackingPayer bulletins and policy changes monitored, so new rules reach your team before they cause denials.

Where revenue leaks

The problems we fix

Missing prior authorization
Services performed without a required authorization are one of the most common avoidable denials. We appeal where possible and fix the scheduling workflow that missed it.
- CARCCO-197Precertification or authorization absent
Medical necessity denials
When the payer says the documentation doesn't support the service, we appeal with the clinical record and the payer's own coverage policy.
- CARCCO-50Not deemed a medical necessity by the payer
Eligibility and coverage gaps
Terminated coverage or the wrong payer on file leads to denials that are fixable before the visit. We fix the claim and add the eligibility check upstream.
- CARCCO-27Expenses incurred after coverage terminated
Duplicate claim denials
Resubmitting instead of correcting creates duplicate denials. We use the right claim frequency code so corrections are processed, not rejected.
- CARCCO-18Exact duplicate claim or service

How it works

Getting started with denial management

Week 1
Denial audit
We analyze 6 to 12 months of remits under a signed BAA and rank denials by dollars and reason.
Week 2
Work the open denials
Recoverable denials are corrected or appealed, closest to their appeal deadline first.
Ongoing
Two-day turnaround
New denials are triaged and worked within two business days of the remit.
Every month
Prevent
We review denial trends with you and change the upstream step: intake, coding, authorization or charge entry.

Benchmarks

The numbers we report against

Industry benchmarks and our own service targets. We measure your baseline in a free review and report against it every month.

<5%

Denial rate

Common industry target, as a share of claims submitted

≤2days

Denial turnaround

Our target from remit to correction or appeal

FAQ

Denial Management: common questions

Do you work denials from claims you didn't submit?

Yes. Many practices start with denial management only. We work denials from your existing process and report on where they come from.

How do you decide whether a denial is worth appealing?

We weigh the dollar value, the payer's appeal success history for that reason code, and the deadline. Low-value denials with no realistic path are flagged for your approval before write-off.

Will you need access to clinical documentation?

For medical necessity and coding appeals, yes. Access is read-only, role-based and covered by the Business Associate Agreement we sign before starting.

How quickly will we see a change in our denial rate?

Open denials start converting to payments within weeks. The denial rate itself usually moves after one or two monthly cycles, once upstream fixes are in place.