Services / Claims Submission & Denial Management
Claims Submission & Denial Management
CLAIMS SUBMISSION & DENIAL MANAGEMENT, GUARANTEED
A denied claim isn't rejected.
It's revenue you already earned — waiting to be reclaimed.
It's revenue you already earned — waiting to be reclaimed.
Most practices don't lose money at the point of care. They lose it in the weeks after submission — in denials that pile up and follow-ups nobody has time for.
Reviora's Claims Submission & Denial Management service closes that gap. Every claim gets a specialist's review before it leaves the building, every denial gets root-cause triage instead of a blind resubmission, and every outcome is written into your Managed Outcomes Agreement — not left to a dashboard percentage no one is accountable for.
11.8%
average initial claim denial rate across U.S. practices in 2024 — Reviora's MOA guarantees under 5%
Source: Kodiak Solutions / HFMA, 2024
60%
of denied claims are never reworked industry-wide — becoming permanent, written-off revenue
Source: HFMA, 2024
$25–$118
average cost to rework one denied claim — climbing sharply the longer it sits unresolved
Source: MGMA / AAPC Denial Management Benchmarks, 2024
HOW REVIORA WORKS YOUR CLAIMS
Every claim gets a specialist's eyes before it ever reaches a payer.
No black box. No "the system flagged it." Here's exactly what happens to your claims, and who's accountable for each step.
Pre-Submission Specialist Scrub
Eligibility, coding accuracy, and authorization checks completed by your Specialist before a claim ever leaves the building — catching the errors that cause the majority of denials before they happen.
Root-Cause Denial Triage
Every denial is classified by cause, not just resubmitted. If the same error keeps showing up, we fix the upstream process — not just the individual claim.
Fast, Targeted Appeals
Appeals are filed by a Specialist who knows your payer's specific patterns, on a timeline built around one finding: appeals filed early consistently recover more than appeals filed late.
Your Account Manager Owns the Outcome
A named AM is accountable for your SLA and QA on every account — with live visibility into every open claim, not a monthly summary after the fact.
THE MANAGED OUTCOMES AGREEMENT
We don't promise fewer denials. We guarantee a number, written into your contract.
Hover or tap a card to see how it compares to the industry.
97%
Clean Claim Rate
Fewer rejections, faster payments, less rework for your team.
<5%
Denial Rate
Top-performer threshold — strong front-end and coding discipline.
90%
First Pass Resolution Rate
More claims paid on first submission — no edits, no rework.
Find out exactly what your denials are costing you — before your next billing cycle.
Free, no-obligation. We'll show you your numbers against the industry benchmark — not just a sales pitch.
Get My Free Claims & Denial Benchmark Assessment
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