Insurance and revenue
Denial management software that works every denial to recovery.
Every denial read, fixed, resubmitted or appealed, then tracked to payment.
Denied claims, sorted this morning
| Claim | Status |
|---|---|
| CLM-48213 | Working |
| CLM-48227 | Working |
| CLM-48240 | Working |
| CLM-48252 | Working |
| CLM-48266 | Working |
Read from the 835 the day it posted. One action per claim, every reason kept.
Every denial that is not worked is revenue the clinic already earned and never collects. Working all of them, and fixing the causes, is where recovered revenue comes from.
Every
denial read the day it lands
0
appeals left without a follow-up date
What denial management should mean for a small billing team
Denial management is reading every denied claim, deciding what each one needs, doing that work, and following it until the money arrives or the line is closed with a reason. Most clinics manage the first part and run out of hours before the rest.
Industry figures commonly put initial denial rates for outpatient practices in the 5 to 15 percent range, and a large share of denied claims are never reworked at all. The cause is rarely skill. It is the queue: a biller who spends the morning on today's charges has no afternoon left for last month's denials.
2care treats that queue as work to finish rather than a report to read. Every denial is picked up from the remittance the day it posts, given one action, and worked until it is paid, resubmitted, or written off with a reason your team can see.
The appeal, drafted
An appeal letter built from the chart instead of a template
A claim denial appeal wins on evidence the reviewer can find in seconds. The draft puts that evidence on the first page.
First level appeal, CLM-48213
Appeal letter, draft
Re: Claim CLM-48213, DOS 08/14/2026
Patient: Maria L., Commercial PPO
Denied CO-197: precertification absent
Auth PA-77310 approved 08/02/2026
Valid 08/02 to 10/31, CPT 20611, J7325
Note 07/28: 12 weeks PT and NSAIDs failed
Payer policy 4.2: criteria met
Request: reprocess under approved auth
Waiting for biller approval. Sent through the payer portal once approved.
From remittance to recovered dollars, one claim at a time
Read the 835 the day it posts
Every denied or reduced line is pulled from the remittance with its CARC and RARC codes, the amount paid and the amount your fee schedule expected.
Name the cause in plain terms
Codes are mapped to a cause your team recognises: missing auth, payer order, eligibility, coding, missing information, timely filing, or a contract underpayment.
Pick one action per claim
Each claim is set to fix and resubmit, appeal, or write off with a reason. Anything that needs judgement, such as a medical necessity dispute, goes to a biller with the evidence attached.
Make the fix or write the appeal
Corrected claims are rebuilt with the right modifier, payer order or auth number and refiled. Appeals are drafted with notes and policy language and sent once approved.
Follow it until the payer answers
Resubmissions and appeals are checked on a schedule until the payer pays, upholds, or asks for more. If a first level appeal is upheld and the record supports it, a second level is drafted.
Post the payment and close the line
The payment is reconciled to the original line, any balance that is now the patient's moves to patient billing, and the cause is logged for reporting.
Fix it upstream
Which denial reasons keep coming back, and where each one is prevented
Denials by cause, last quarter
Illustrative mix. Each cause is linked to the step that prevents it.
Missing auth goes back to prior auth
When CO-197 leads the list, the fix is checking auth on scheduled procedures earlier, not writing faster appeals.
Payer order goes back to benefits coordination
CO-22 usually means the wrong plan was billed first. A coordination of benefits check at intake removes most of these before they are filed.
Eligibility goes back to verification
Inactive coverage on the date of service is caught by checks before the visit, while the patient can still give you the new plan.
The difference
A denial queue worked when there is time, next to one worked daily
Worked when someone can
Worked by 2care
When a denial is noticed
When somebody opens the remittance, often days later
The day the 835 posts
Which denials get worked
The large balances, if the week allows
Every denied line, including the small ones
How the appeal is written
A saved template, edited by hand
Drafted from the chart, the auth record and the payer policy
Appeal deadlines
Kept in a spreadsheet, or in somebody's head
Printed on every draft, with follow up dates set
After the appeal goes out
Checked again if somebody remembers
Status checked on a schedule until it pays or closes
Causes that repeat
Fixed one claim at a time, every month
Reported by reason and fixed where the claim starts
One appeal, start to finish
How a single CO-197 denial turns into a posted payment
CLM-48213, Maria L.
Denial posted
835Oct 2CO-197 read from the 835
Sorted to appeal
Oct 2Auth PA-77310 found on the chart
Letter drafted
Oct 3Notes, auth and policy attached
Approved and sent
PortalOct 3Biller approved, filed by portal
Status checked
276/277Oct 17In review, next check in 7 days
Paid and posted
835Oct 29$412.00 reconciled to the line
Closed with the reason logged against missing auth upstream.
Where the line sits
The recovery work it takes on, and what stays with your billers
What it does
- Read every denied and reduced line from the remittance
- Correct and refile claims with clear, fixable errors
- Draft appeals with cited notes, auth records and policy text
- Track appeal deadlines and check status on a schedule
- Report denial causes so they can be prevented
What it leaves to your team
- Change a code a clinician chose without review
- Send an appeal your biller has not approved
- Write off a balance without a recorded reason
- Speak for the provider in a peer to peer review
- Bill a patient for an amount the payer still owes
Medical necessity disputes reach the provider with the exact note the payer asked for.
The recovery view
Denied, appealed and recovered dollars on one screen
Denial recovery, this quarter
Denied
$84,600
Appealed
$41,200
Recovered
$52,300
Includes resubmissions
Recovery rate
62%
Up from 38% last quarter
July
August
September
Sample dashboard with fictional figures.
See it work
The call your billing team keeps putting off
A pending claim chased with the payer: the status, the missing records, where to send them, and a reference number logged on the claim.
Insurance and revenue
The rest of the workflow.
Before you hand over the denial queue
What billing leads ask about denial recovery.
Denial management software reads denied claims from the remittance, works out why each was denied, and helps fix, appeal or close it. 2care goes further than reporting: it makes the corrections, drafts the appeals and follows each one until the payer pays or the line is closed.
Every denied or reduced line on the 835, including coding and modifier errors, missing information, payer order, eligibility, missing auth, timely filing and medical necessity. Underpayments against your contracted rates are flagged the same way.
Each appeal is a draft until a biller approves it. The approval screen shows the letter, every attachment and the deadline, and nothing goes to the payer without that click.
Denied claims are read and sorted the day the remittance posts. Clear fixes are resubmitted that day, and appeals are drafted within a day so they are waiting for approval rather than waiting for someone to start them.
The upheld decision is read, and if the record supports it a second level appeal is drafted with any new evidence the payer asked for. If it does not, the claim is written off with the reason recorded and your team can see why.
Both. Every closed denial is logged by cause, and the top causes are traced back to the step that prevents them: prior auth checks, benefits coordination, eligibility checks or new scrub rules.
Built for regulated healthcare, in every market we operate in
HIPAA
United States
BAA available on request
GDPR
UK & Europe
DPA available, data hosted in the EU/UK
DPDP
India
Data residency in India
See your denial backlog worked. Book Demo.
30 minutes, on your own workflows. No commitment.
- 95+ integrations and EHRs
- ·Live in weeks, not months
- ·HIPAA, GDPR and DPDP