BEHAVIORAL HEALTH CLINIC
Before90+
After<40
$1M recovered in 75 days
Targeted denial management and automated claim workflows on an AR backlog.
Read the case study →Medical specialties
Primary and family care
Surgical and procedural
Dental, DME and labs
Revenue cycle · one rate
Front end · before the visit
Patients, insight and growth
Clinical documentation
Revenue operations
Voice automation
Denial management · AR recovery
PhysiAssist Health is a denial management company for specialty practices, ASCs and hospital groups. Certified coders and AR specialists work every denied and unpaid claim to payment, trace each denial to the step that caused it, and fix that step so the same denial stops coming back. You see every claim, its denial code and the person working it, live.
Follow one denial to payment. Click any step →
Illustrative example with sample data
The basics
Denial management is the work of recovering payment on claims a payer has refused, and preventing the same refusals in the future. It covers four jobs: sorting denials by reason code and payer, correcting and resubmitting or appealing each claim before its deadline, following up until the payer pays, and fixing the upstream step, such as registration, authorization or coding, that caused the denial.
Work starts from the claim adjustment reason code (CARC) and remark code (RARC) on the remittance. Each code points to a different fix.
Work starts from the aging report: every open balance by payer and age. It catches claims the payer never processed, underpaid or quietly lost.
A denial nobody works becomes aged AR, and aged AR hides denials nobody has seen. We run them as one workflow with one owner per claim.
Industry data
Denied does not mean lost. The cost is the work of appealing, so the goal is to appeal efficiently and stop repeat denials at the source.
Share of providers naming each cause. Experian Health, State of Claims 2025. All three causes start before the claim is sent, which is why we fix the front end, not only the appeal.
Denial codes
Every remittance carries a claim adjustment reason code. The group prefix tells you who owes: CO is the provider's contractual obligation, PR is patient responsibility. Pick a code.
The claim lacks information or has a submission or billing error.
Precertification, notification, authorization or pre-treatment was absent.
The payer does not consider the service medically necessary.
The service is included in the payment for another service already adjudicated.
The service, equipment or drug is not covered under the patient's current benefit plan.
The time limit for filing has expired.
The charge exceeds the fee schedule or contracted amount.
Code descriptions paraphrased from the X12 claim adjustment reason code list.
Our process
Every denial gets an owner, a deadline and a reason. Nothing sits in a queue without a name on it.
Every electronic remittance (835) and payer letter is read the day it arrives. Denials are tagged by reason code, payer, provider and dollar value.
The queue is worked by deadline and dollars: claims closest to an appeal or filing limit first, then the largest balances.
Corrected claim, reopening or appeal, with the records, policy citation and letter each payer expects. Coders take coding denials; AR specialists take payer issues.
Our AR voice agent calls payers for claim status on a schedule and logs every answer on the claim. People take the calls that need judgment.
Denial analysis groups denials by root cause. We fix the step that caused them: a registration field, an authorization rule, a scrubber edit or a documentation template.
Software behind it:RevCoreDenial analysisAR voice agentAI medical coding
AR recovery
Receivables get harder to collect the older they get. We split your aging report into buckets and work each one differently, oldest money with a deadline first.
Open AR by age · sample practice
Illustrative example with sample data. Your targets are agreed at handoff, usually days in AR and the share of AR over 90 days.
Clearinghouse rejections fixed the same day, status checks before claims stall, eligibility and coordination-of-benefits corrections.
Payer calls, reprocessing requests, corrected claims and appeals, and clear patient statements for balances after insurance.
AR cleanup projects: proof of timely filing, higher-level appeals, credentialing holds, and documented write-offs so your books show what is truly collectible.
By specialty
Most denials in specialty care come from a handful of rules each specialty lives with. Our coders work in one specialty, so they know them.
Drug units per HCPCS descriptor, JW and JZ waste modifiers, the infusion coding hierarchy, and authorizations that run out mid-regimen.
Oncology billing services →Time-based psychotherapy codes and add-ons with E/M, telehealth place of service and modifiers, authorizations for intensive programs and testing, and sleep study medical-necessity rules.
Behavioral health billing →EMG and nerve conduction codes billed by the number of studies, EEG bundling, MS and migraine infusion drug units, and imaging authorizations.
Neurology billing services →Biologic step-therapy denials, buy-and-bill drug units such as infliximab per 10 mg, and site-of-care policies for infusions.
Rheumatology billing services →Global periods, distinct-procedure modifiers, multiple-procedure reductions and implant lines on surgery center claims.
ASC and surgical billing →Open books
Your team gets the same denial worklist ours works from in RevCore: the code, the root cause, the next action, the deadline and the person on it.
Results
Pricing
Included in full revenue cycle management. When we run your revenue cycle, denial management and AR follow-up are part of one rate: 2.8% to 5% of net collections, in writing before you sign.
As a standalone project. For an old AR cleanup, we review your aging report first and quote the fee in writing before any work starts.
How our pricing works →Reading every remittance for denials, sorting them by reason code and payer, correcting and resubmitting or appealing each claim before its deadline, following up with the payer until it pays, and fixing the upstream cause, such as a registration field, an authorization rule or a coding pattern, so the denial does not repeat.
Denial management works claims the payer has refused, starting from the denial code. AR recovery works every unpaid balance on the aging report, including claims the payer never processed or underpaid. A denial that is not worked becomes aged AR, so we run both as one workflow.
There is no single official benchmark. In Experian Health's 2025 State of Claims survey, 41% of providers reported denial rates of 10% or higher, so a rate in the single digits puts a practice ahead of many peers. We report your rate by payer and by root cause, which shows what to fix.
Often, yes. If the claim was filed on time and you can prove it, it can usually still be appealed or reprocessed. For Medicare, a redetermination must be requested within 120 days of receiving the initial determination; commercial appeal deadlines are set by each contract. Claims past every deadline are written off with a documented reason so your AR is accurate.
CO-197 means the payer found no precertification, notification or authorization for the service. It is fixed by matching an existing authorization to the claim, requesting a retro-authorization where the payer allows it, or appealing with the clinical record, and prevented by checking authorization at scheduling.
CO-16 means the claim lacks information or has a billing error. The remark code on the remittance names the missing or invalid field. It is fixed by correcting that field and sending a corrected claim, not by an appeal.
With a review of your aging report and your last 90 days of remittance data. It shows where the money is and which denials repeat. Work starts once system access and a business associate agreement are in place.
Yes. We can take denials and aged AR as a standalone service while your team keeps charge entry and the front desk. You can also license our denial analysis and AR voice agent for your own staff.
A 30-minute review with a denial specialist in your field. A summary by code and payer is enough to start, with no patient information.