Revenue cycle work carries financial, contractual, coding, and clinical consequences. A credible managed model separates the administrative actions MedArise owns from the decisions the practice must retain.
What denial management services should deliver
The deliverable is not a list of denial codes. Within an agreed scope, MedArise can gather payer responses, connect them to claim context, classify the work, prioritize the next action, check status, complete approved administrative corrections or follow-up, preserve evidence, and reconcile the final disposition.
Each item needs an owner, deadline, next action, evidence requirement, authority boundary, and close reason. The operating report should also show recurring upstream patterns so the practice can distinguish recovery work from prevention opportunities.
When services are missing before claim creation, denial follow-up starts too late. The charge capture in medical billing guide separates encounter reconciliation, coding authority, charge entry, claim creation, and submission so a practice can find the actual handoff gap.
Land with a queue or transition the full function
A practice can begin with denial follow-up, aging A/R, claim status, or another bounded revenue queue. A complete RCM transition happens only after discovery defines systems, authority, exclusions, reconciliation, and responsibility for collections.
Administrative exceptions may include payer portal recovery, status clarification, missing non-clinical information, duplicate work, or an approved corrected-claim step. Coding, medical necessity, clinical documentation, contract disputes, write-offs, and financial decisions remain with authorized people.
The Denial Report is a diagnostic entry point
Practices that are not ready to transfer an operating queue can begin with a scoped denial analysis. The report identifies denial mix, root causes, aging, and priority actions, then shows which work MedArise could take over.
Pricing follows responsibility
Narrow managed work is priced around its actual workload and operating scope. Full RCM may use percentage-of-net-collections pricing only when MedArise owns the corresponding submission, payment, denial, A/R, payer follow-up, and reporting responsibilities.
For a bounded denial service, define the included claim population, aging, systems, follow-up frequency, correction authority, appeal boundary, reconciliation, exclusions, and unit of volume. Start with the denial management software buyer guide to compare operating capabilities, or request the complimentary denial opportunity report before transferring a queue.
Frequently asked questions
What do denial management services include?
A defined service can classify payer responses, retrieve claim context, prioritize work, check status, complete approved administrative corrections or follow-up, preserve evidence, reconcile the disposition, and report recurring upstream causes.
Which denial decisions should remain with the practice?
Coding changes, medical-necessity judgments, clinical documentation, contract interpretation, write-offs, settlement authority, and other financial or clinical decisions remain with authorized practice staff.
How should a practice start managed denial follow-up?
Begin with a defined denial category, payer, aging band, location, or claim population. Establish a diagnostic baseline, action authority, deadlines, reconciliation rules, and completion measures before expanding.
Not ready to transfer a queue?
Start with a scoped denial analysis.
See the denial mix, recurring causes, aging, and highest-priority actions before deciding what MedArise should own.
Explore the Denial Report →