Recover Lost Revenue. Resolve Claim Denials. Optimize Your Bottom Line.
Claim denials are more than a routine inconvenience—they represent a direct hit to your practice’s revenue and efficiency. Without a solid strategy to address denials and follow up on appeals, you risk leaving thousands of dollars on the table each month.
At Pristinesolutions, our Denial Management and Appeals services are designed to identify the root causes of claim denials, resolve them quickly, and recover lost revenue. We combine advanced analytics, payer expertise, and proven appeal strategies to get your claims paid—fast.
The Cost of Unmanaged Denials
The average healthcare practice sees 5–10% of claims denied on first submission. And unfortunately, many of those claims go unworked due to lack of time, knowledge, or resources.
Unaddressed denials lead to:
- Lost revenue and increased write-offs
- Delays in reimbursement and cash flow issues
- Compliance risks from recurring billing errors
- Increased administrative burden on your staff
What Our Denial Management Services Include
Denial Identification
& Categorization
We analyze and classify denials by type (e.g., eligibility, coding, authorization, coverage limits) to determine trends and correct the source of errors.
Corrective Action
& Reprocessing
Beyond fixing denials, we identify underlying workflow or documentation gaps to prevent recurring problems. We deliver clear reports with actionable insights.
Payer-Specific
Appeal Preparation
When required, we prepare structured appeal letters backed by medical necessity, clinical notes, and payer guidelines to defend your claims.
Tracking & Timely
Follow-Up
We monitor appeal deadlines and ensure timely submissions with ongoing payer communication until the claim is resolved.
Root Cause Analysis
& Reporting
We don’t stop at submission. Our credentialing specialists follow up regularly with insurance companies to ensure timely approval, address issues, and keep you informed with status updates.
How We Serve
We provide credentialing services for a wide range of healthcare professionals and organizations, including:
- Eligibility and coverage denials
- Authorization/pre-certification denials
- Incorrect or missing coding (CPT/ICD)
- Duplicate or untimely submissions
- Medical necessity denials
- Coordination of benefits (COB)
- Bundled services and modifier errors
Why Choose Pristonsolutions
Appeal Experts
on Staff
Our billing specialists are trained in both clinical interpretation and payer policies.
Faster Recovery
Times
We address denials within 24–48 hours to shorten your A/R cycle.
Specialty-
Focused Support
We understand the unique denial challenges in behavioral health, radiology, therapy, surgery, and more.
Customized
Strategies
We don’t just resubmit—we resolve the root cause of the issue.
Data-Driven
Decisions
Our reports help reduce your overall denial rate and improve first-pass claim acceptance.
Trusted Partners
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