What this page covers
Denial management services take on the claims a payer refused or reduced: identifying the reason, correcting or appealing the claim, and feeding the pattern back so the next one does not deny. Denials are a large source of lost revenue and are rarely appealed. Flexbone runs denial management AI-first: agents read the 835 remittance and route each denial by its codes, and US-based staff work the appeals.
What denial management services do
A denial management service works denied and underpaid claims on a practice or health system behalf. It reads the remittance, categorizes the denial, decides whether to correct and resubmit or to appeal, gathers the documentation, and tracks the outcome, then reports the patterns so the front end can prevent repeats. The value is focus: denials are detailed, deadline-bound, and easy to deprioritize against fresh claims, so a dedicated service recovers revenue that would otherwise be written off. Claim denials are a large and under-worked problem; KFF found insurers denied 20% of in-network HealthCare.gov claims in 2023 and consumers appealed fewer than 1% (KFF analysis of 2023 claims data).
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The denial management process, step by step
The process is consistent. Read the 835 remittance and identify the CARC and RARC codes that explain the adjustment. Categorize the denial as eligibility, authorization, coding, timely filing, coordination of benefits, or medical necessity. Decide whether it is a correctable error to rebill or a true denial to appeal. Assemble the documentation the appeal needs and submit it within the payer deadline. Track the outcome and feed the root cause back to the front end so the same denial does not recur. The denials management page covers the mechanism in depth.
AI-first denial management versus a labor shop
Most denial management services scale by adding people, and the repetitive first steps, reading the remittance, categorizing by code, and pulling documentation, consume a large share of that labor. An AI-first service runs those steps with agents and routes only the judgment calls, the appeals and the complex accounts, to staff. Denials are worked consistently and quickly, and cost does not scale one-for-one with volume. It is the difference between renting appeal labor and buying resolved denials.
How Flexbone runs denial management
Flexbone pairs AI voice and browser agents with US-based human staff through our partnership with Nav Central, a 24/7 clinical command center. The agents run the repetitive keystrokes and phone calls, and the Nav Central team steps in where a task needs a person. In our own deployment, that model made more than 300 staff AI-powered and removed over 1,000 hours of manual work a month (Nav Central case study). It is an AI-first service with people behind it, not labor billed by the seat. On denials specifically, the agents read the 835, categorize each denial by CARC and RARC, rebill correctable errors, and assemble appeal packets, while staff work the appeals and peer-to-peer reviews. The deployment is HIPAA compliant and scoped to your payers and denial mix, and it feeds root causes back to eligibility and prior authorization so the same denials stop recurring.