Don’t limit your potential by ignoring claim denials. Did you know that over 86% of denials are easily avoidable? Each denied claim represents a missed opportunity. While this may seem like a minor setback at first, it can quickly lead to significant losses. Unresolved claims can cost healthcare practices up to 5% of their net patient revenue. Therefore, you need an effective management process to avoid such issues.
But the real question is, do you have the time and resources to fix and resubmit every denied claim? Denial management can be a time-consuming and draining process, which is why we are introducing the top 10 denial management companies. Let’s find the right partner for your growth!
Top 10 Denial Management Companies in the USA
Claim denials are perhaps the biggest hurdle to the growth of healthcare practices. According to Experian’s latest State of Claims report, 38% of respondents stated that insurance companies deny one out of every ten claims. Additionally, 73% of healthcare providers have experienced an increase in claim denials.
As a result, the market size of denial management is growing at an exceptional rate and is estimated to reach $5.94 billion by 2027. Many outsourcing companies also offer these services, but only a few specialize in the claim rework process. Here is the list of the top 10 denial management companies.
1. MediBill MD
With a deep understanding of the claims process and a proven track record of successfully reducing denial rates, MediBill MD is the top choice of healthcare providers. Don’t judge it by its founding date! Although MediBill MD is just one year old, its denial management services are supported by a highly experienced team of billers and coders.
Another key strength of this company is that it resolves claim backlogs of all types of healthcare practices across more than 50 specialties. MediBill MD is a top name in our denial management companies because it offers personalized support at every step of your claim resolution process.
The company provides detailed denial analysis and files timely appeals with proper follow-ups. So, if you want guaranteed results at affordable prices, you can contact MediBill MD’s representatives through its website to get started.
2. Aspirion
Are you searching for an award-winning company? Look no further! With offices across multiple states, Aspirion has one of the broadest footprints among other denial management companies in the US. The company serves over 1,000 clients in all 50 states and has resolved almost 800,000 accounts. Its trustworthy end-to-end revenue recovery solutions have collected more than $3.3 billion, improving the financial situation of many clients.
Recognized as the best denial management company by KLAS – a healthcare research company, Aspirion has a team of over 180 legal professionals and 80 clinicians. The company stands out for its commitment to maximizing reimbursement regardless of the claim type.
The best thing about Aspirion is that it offers round-the-clock access to valuable insights, such as information about claims and collections volume, through its client portal, Aspirion Intelligence.
3. Managed Resources
Managed Resources, located in Long Beach, a coastal city in southern California, is also one of the featured denial management companies in KLAS’ latest report. With an average experience of over 20 years, its professional clinical appeals team, consisting of registered nurses and compliance specialists, helps recover revenue lost due to inappropriate claim denials.
From denial analysis and professional appeals to timely follow-ups, Managed Resources guarantees accurate reimbursements through comprehensive support. The company usually helps several specialties, including high-impact ones such as medical necessity, trauma, and oncology.
It prioritizes accurate and prompt reimbursements and takes proactive measures to prevent future denials. You can partner with Managed Resources for expert insights and better quality control.
4. Revecore
Are you searching for a company that specializes in complex claims recovery? We might have the perfect solution for you! Based in Franklin, Tennessee, just south of Nashville, Revecore is an excellent choice for recovering what you have lost in claim denials. With over 25 years of experience, this company excels in resolving complex claims, including motor vehicle accidents and workers’ compensation.
Revecore has been recognized as one of KLAS’ top denial management companies since 2021, highlighting its credibility. It improves the financial health of hospitals struggling with complicated requirements through advanced technology and exceptional client support.
What truly sets Revecore apart is its consultative, client-focused approach, which combines proprietary technology with specialized experience to minimize claim denials. Moreover, the company increases its appeal by offering transparent performance analysis and pricing.
5. Xsolis
Do you want to know about another firm in Franklin, Tennessee, that has made it to our list of the best denial management companies? Founded in 2013, Xsolis was established to bridge the gap between healthcare providers and payers. Since then, it has experienced rapid growth, expanding from a small team of 5 to over 275 members.
Xsolis is committed to improving payer-provider collaboration and transforming denial management through advanced technology (AI and ML). It takes a unique approach to identify denied claims with justified clinical merit, allowing hospitals to recover lost revenue more efficiently.
With a specialized team of clinical, legal, and revenue cycle experts, the company simplifies the appeal process for faster recovery and improved outcomes. Want to strengthen your revenue? Choose Xsolis for a healthier revenue cycle.
6. AMBSI, Inc.
Located in Sayreville, a borough in New Jersey’s Middlesex County, AMBSI is also one of the top denial management companies in the US. The company handpicks the best coding and billing professionals based on their expertise and provides them with continuous education to resolve and address your higher denial rates.
Like many leading firms, AMBSI maintains an extensive database of payer-approved services and procedures, including their rates, to ensure compliance. It meticulously investigates each rejection to identify the root cause and then takes a tailored approach to make all the necessary corrections. This often includes correcting invalid codes and providing essential documentation. Its focus on accuracy and simplified processes significantly reduce overhead costs and denial rates.
7. Claims Med, Inc.
Claims Med, based in Sugar Land, a suburban city in Texas, can also help you reclaim your revenue. It stands out as one the best denial management companies in the US due to its specialized focus on resolving aged claims – 60 to 90 days old outstanding medical claims.
Since Meds Claim understands the challenges healthcare practices face in processing older claims, it employs a proactive, twofold strategy. This includes comprehensive follow-ups on rejected or denied claims and thorough denial analysis. Its seasoned professionals guarantee optimal revenue recovery by effectively engaging with both insurance providers and patients.
In short, Meds Claim frees you from the burden of uncollectible accounts while preserving good patient-provider relations. Hence, it is the best choice for addressing your old A/R.
8. MGSI, LLC (Medical Group Services)
Headquartered in Tampa, Florida, MSGI is a national revenue cycle management company that also specializes in denial management. With over 29 years of experience, it offers comprehensive revenue recovery solutions, including A/R follow-ups, claim status checks, and appeal letter generation, to a wide range of healthcare groups in multiple states.
MSGI covers 25+ specialties and provides dedicated support to address denied claims and identify their root causes. Furthermore, it implements preventive measures to avoid future denials and guarantees the timely recovery of outstanding accounts. With its extensive experience and commitment to improving cash flow, MSGI is recognized as one of the best denial management companies of 2024.
9. EnableComp
EnableComp, a specialty revenue cycle solutions provider based in Franklin, Tennessee, has earned its spot on our list. It is now recognized as one of the top denial management companies in the U.S., especially following its recent acquisition of ANI Healthcare Solutions, a San Francisco-based denial resolution firm. This strategic move has helped it improve its offerings.
EnableComp’s advanced denial management solutions guarantee 100% recovery of expected reimbursements. It specializes in resolving complex claims for both private and government healthcare agencies. The company’s proprietary E360 RCM™ platform offers root-cause analysis and in-depth insights into denial trends.
In simple words, this platform empowers healthcare providers to maximize revenue opportunities. With a 97% client retention rate and over $5 billion collected in cash, EnableComp is an exceptional choice for filing your appeals.
10. Plutus Health
Want to partner with a company that plugs your revenue leakage? Plutus Health is the perfect option, with over 14 years of experience. Headquartered in Dallas, Texas, this company follows a proven process to tackle all your problems, including reducing claim denials, recovering aging A/R, and handling all the paperwork.
Like all other best denial management companies on our list, Plutus Health also takes a custom approach to address your unique requirements, ensuring timely resolutions. The company also identifies and solves systematic gaps in your existing processes to prevent future claim rejections.
The best thing about Plutus Health is that it takes the time to understand your needs. Moreover, its team has a keen eye for facility or specialty-specific issues that may result in claim denials, creating effective solutions to resolve them.
Things to Consider When Choosing a Denial Management Company
Only you can truly understand your unique needs! A company may look perfect on paper, but it still might not be the best choice. Are you feeling torn between our top options? Here are a few key factors to help you make an informed choice.
Industry Experience
Would you hand over everything to a new company, or do you feel more comfortable with experienced professionals? The answer is quite obvious! Denial management is a crucial part of a healthier revenue cycle. Any company can claim to be experienced.
So, how can you make a reliable choice? By focusing on three things: proven track record, customer reviews, and certifications. Look for ISO-certified denial management companies with a high customer retention rate backed by proven results.
Focused Specialties & Service Scope
It is common knowledge that not all companies cover every specialty. So, choose a name that understands your field to avoid future problems. Moreover, review the types of claims they manage (some companies only take simple cases). Don’t make hasty decisions!
Regulatory & Insurance Compliance
Insurance companies immediately deny non-compliant claims. So, always choose a partner that understands local regulations and payer-specific requirements. Also, check their security standards to make sure their denial management solutions are HIPAA compliant.
Customization & Transparency
Transparency is key, especially in pricing and performance. Opt for denial management companies that offer clear pricing structures and tailored solutions that meet your needs.
Bottom Line
From award-winning firms to innovative options, our list has everything! We understand that choosing the right partner can be quite overwhelming. Therefore, instead of selecting names after a quick research, we have compiled the top 10 denial management companies based on 7 factors – experience, accessibility, transparency, technology adoption, customer support, performance, and customer reviews. You can trust any of these companies to help you with your claim resubmission process.
