Denied claims aren’t just numbers—they represent lost revenue, frustrated staff, and delayed patient care. At 5 Star Billing Services, we treat every denial as an opportunity to recover revenue, strengthen your financial workflow, and protect the health of your practice. Our Denial Management Services are built to uncover the why, fix the root causes, and ensure your claims get paid—accurately, compliantly, and on time.
A large portion of denials are avoidable—but without dedicated follow-up, practices end up losing thousands every month.
Denied claims sit in aging buckets (60–120+ days), slowing cash flow and hurting practice stability.
Internal teams waste hours correcting the same issues repeatedly, reducing overall productivity and increasing burnout.
Missing clinical notes, incorrect modifiers, or inaccurate coding lead to repeated denials that are hard to track and prevent.
Medicare, Medicaid, and commercial payers constantly update rules—making compliance difficult and denials more common.
Most practices don’t have analytics to understand why denials happen, so the same mistakes continue unchecked.
Insurance changes, expired authorizations, and incomplete verifications are major triggers for initial claim rejections.
Practices often lack time and expertise to prepare strong, timely appeals—leading to lost revenue that could have been recovered.
High-complexity specialties like Cardiology, Orthopedics, Mental Health, and Allergy face unique coding issues that trigger high denial rates.
We perform advanced claim scrubbing, coding checks, and documentation validation before submission—eliminating avoidable denials and protecting your revenue.
Every denied claim is worked immediately. We correct, resubmit, and follow up consistently to keep aging buckets under control.
Your team stops wasting hours on complex denial rework. Our specialists handle all corrections, payer communication, and resubmissions.
Certified coders ensure your claims have complete documentation, correct modifiers, and accurate CPT/ICD-10 codes—preventing future denials.
We track Medicare, Medicaid, and commercial payer updates daily to ensure every claim meets current standards and avoids rule-based rejections.
You receive clear reporting on denial trends, payer patterns, and root causes—so you always know where workflow improvements are needed.
We verify coverage, benefits, and prior-authorizations upfront to stop insurance and authorization-related denials before they happen.
Our team prepares detailed appeals with medical necessity, coding references, and required documentation to overturn denials effectively.
We analyze every denied claim to pinpoint the exact issues—coding errors, missing documents, eligibility mistakes, or payer-specific rules.
Our specialists correct all errors, update codes/modifiers, complete missing data, and resubmit claims quickly to speed up reimbursements.
We prepare strong, payer-compliant appeals with supporting documentation, medical necessity justification, and detailed coding references.
We validate patient coverage, benefit limits, plan changes, and payer requirements to prevent future denials from happening again.
Our team checks required authorizations, validity dates, and documentation to ensure compliance with payer rules.
Certified coders review clinical notes, CPT/ICD-10/HCPCS codes, modifiers, and supporting documentation to ensure claims meet speciality-specific standards.
We communicate directly with payers to resolve questions, request reconsiderations, check claim status, and ensure timely processing.
We manage technical, clinical, administrative, coding, and authorization-related denials with specialty-specific expertise.
Our team works older unpaid claims to recover revenue that is often forgotten or written off by practices.
You receive clear dashboards and reporting that reveal recurring issues—and we build corrective processes to prevent them long-term.
All processes follow HIPAA, CMS, Medicare/Medicaid, and commercial payer guidelines to ensure clean, audit-ready claim resolution.
From complex surgical coding to behavioral health documentation, we tailor our denial management service for every provider type.
From compliance to collections — we simplify every step of your revenue cycle.
Our clean claim submission process minimizes rejections and accelerates reimbursements — helping you get paid faster with fewer follow-ups.
We follow strict data security measures — encrypted communications, limited access, and full HIPAA adherence.
Through continuous claim tracking, automated reminders, and payer-specific workflows, we ensure quicker payment cycles and improved cash flow.
By identifying missed charges, underpayments, and coding errors, our audit-backed billing process boosts your overall collections.
We ensure claims are processed within 1–2 business days after receiving the patient encounter data — reducing delays and denials.
We work with major systems like AdvancedMD, Athenahealth, Epic, Tebra, and DrChrono — no need to switch platforms.
Our team follows the latest CPT, ICD-10, and HCPCS updates to maintain coding accuracy and compliance with payer rules.
From cardiology and allergy to behavioral health and urgent care — we understand each specialty’s coding and billing nuances.
Every client gets a single point of contact to ensure personalized support, clear communication, and faster issue resolution.
From patient eligibility verification to AR follow-up, denial management, and payment posting — we handle the entire revenue cycle.
We conduct periodic internal audits and follow CMS, OIG, and payer compliance guidelines to minimize regulatory risks.
Flexible engagement — scale up or pause anytime. We earn your trust through results, not lengthy commitments.
Double-verification at every stage ensures precise data entry, claim validation, and payment posting accuracy.
We understand payer variations across all 50 U.S. states — including Medicaid, Medicare, and commercial insurance carriers.
Monthly or weekly performance reviews keep you informed about KPIs like collection rates, denial ratios, and revenue growth.
Join hundreds of practices experiencing measurable improvements
Holmes Chiropractic
Medical Director
Medical Director, Pulmonary & Sleep Associates of Marin
Everything you need to know about outsourcing your Denials Management
We don’t just fix denials—we eliminate them at the source. Our process focuses on root-cause analysis, specialty-specific coding accuracy, payer rule compliance, and proactive prevention. With experience across 40+ specialties and coverage in all 50 states, we deliver faster recoveries, fewer denials, and a stronger financial workflow for your practice.
Every denial is addressed immediately, not at the end of the week or month. Our team corrects, resubmits, and follows up with payers daily to reduce A/R days and accelerate reimbursements.
Yes. We manage the full denial cycle—
Our goal is to recover revenue that practices often lose due to incomplete or untimely appeals.
Absolutely. Prevention is a core part of our service. We review coding accuracy, documentation completeness, eligibility checks, authorization compliance, and payer-specific rules to stop avoidable denials before they occur.
We support 40+ specialties, including high-denial areas like Cardiology, Orthopedics, Mental Health, Allergy, Gastroenterology, Neurology, Pain Management, and more. Each specialty receives tailored coding, documentation, and denial-prevention workflows.
Yes. We manage denials for Medicare, Medicaid, commercial insurance carriers, workers comp, and managed care plans across all 50 states. Our team stays updated with changing payer policies and CMS guidelines to maintain compliance and accuracy.
We conduct a comprehensive denial review, checking coding, modifiers, documentation, eligibility, authorizations, and payer policies. This root-cause analysis helps us fix the issue quickly and prevent it from happening again.
Yes. You receive transparent denial analytics, including:
These reports give your practice full visibility into financial performance and workflow gaps.
Yes. We handle all communication—status checks, reconsideration requests, appeals, missing information queries, and follow-ups. This removes the administrative burden from your internal staff.
Definitely. We specialize in A/R clean-up, working aged claims up to 120+ days old. Many of these claims can still be corrected, appealed, and reimbursed—recovering revenue that practices often write off.
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