A denial is not an argument. It is a clock. Medicare gives you 120 days from the date of the initial determination to file a redetermination. A commercial plan governed by ERISA has to give you at least 180 days to file an internal appeal. When those windows close on a claim you would have won, the denial stops being a dispute and becomes a write-off.
Most independent practices lose money in that gap, and the reason is arithmetic rather than incompetence. Premier’s national survey of 516 hospitals, covering claims filed in 2022, found that nearly 15 percent of claims submitted to private payers were initially denied and that more than 54 percent of those denials were eventually overturned and paid. The same survey put the average cost of fighting one denial at $43.84. Read those two figures together: over half the denials were wrong, and proving it costs less per claim than most practices assume. The problem is that nobody in a five-provider office has three uninterrupted hours a week to prove it.
We compared eight companies that sell denial management and appeals as a named service line rather than as a bullet buried inside a general billing pitch. Here is how we judged them: whether they will actually take a practice with one to ten providers, whether pricing is published or quote-only, whether they work denials for you or hand you software to work them yourself, what appeal capability they have beyond resubmission (letter generation, clinical review, payer-specific forms, multi-level filing), and whether the company’s basic business details hold up when you check them.
Five of the eight serve small practices. Three do not, and their entries say so. Knowing which vendors will decline your call is worth as much as knowing which will take it, and this category is full of enterprise firms whose marketing pages do not mention that their floor is $5 million in net patient revenue.
Denial Management Companies Compared
| Company | Location | Best for | Model | Pricing posture | Takes 1-10 provider practices |
|---|---|---|---|---|---|
| SwiftCare Billing | Marlton, NJ | Best overall for independent practices | Full-service billing with denial management built in | Published, from 3% of collections | Yes |
| Neolytix | Chicago, IL | Practices that also want payer contracts renegotiated | Full-service RCM plus contract negotiation | Publishes market ranges, quotes per practice | Yes, solo and up |
| Rivet | Salt Lake Valley, UT | Practices that keep billing in house | Software: denial worklists and appeal automation | Subscription, no percentage of collections | Yes |
| Waystar | Louisville, KY | High appeal volume with payer-specific forms | Software: AI-generated appeal packages | Quote only | Yes, through its practice platform |
| Etactics | Stow, OH | Billing teams that live inside appeal letters | Software (AppealsPlus) inside a claims platform | Quote only | Yes, and billing companies |
| Infinx | San Jose, CA | Imaging, labs and groups with large A/R inventory | Platform plus managed A/R specialists | From $5,000 per month, annual engagements | No, floor of $5M net patient revenue |
| Aspirion | Columbus, GA | Complex claims: motor vehicle, workers’ comp, VA, out-of-state Medicaid | Managed service | Quote only | No, hospitals and health systems |
| Revecore | Franklin, TN | Hospitals chasing underpayments and complex denials | Managed service | Contingency, fees only on cash recovered | No, acute care hospitals only |
1. SwiftCare Billing: best overall for independent practices
SwiftCare Billing is a full-service medical billing company in Marlton, New Jersey, serving practices in all 50 states. Denial management is a named service alongside coding, credentialing, prior authorization, patient billing, A/R, and eligibility verification. The practical effect for a small practice is that the person tracking a denial is the same person who filed the claim, so root cause and correction happen in one place rather than across two vendors who blame each other.
The company tracks denials by category and root cause before deciding whether the right move is a corrected claim or an appeal. That distinction matters more than it sounds. A CO-16 for missing information is a corrected claim and takes minutes. A medical necessity denial is an appeal that needs the clinical note pulled, the coverage policy cited, and a letter that answers the payer’s stated reason rather than restating the original claim. Practices that treat both as “resubmit” spend their timely filing window on the wrong action.
Pricing is published rather than quote-gated, starting from 3 percent of collections, with a worked example on the site of $15,000 in annual billing cost for a practice collecting $500,000. Against the market range Neolytix documents (4 to 10 percent of net collections, 5 to 8 percent for small and mid-size practices), that is at the low end. SwiftCare also states a 98.4 percent clean claims acceptance rate and covers 40-plus specialties including mental health, internal medicine, family practice, podiatry, cardiology, urgent care, orthopedics, and laboratory.
The trade-off is that this is a billing relationship, not an appeals-only engagement. If your billing is working and you want someone to attack a pile of aged denials without touching current claims, say that in the first call rather than assuming it is the default.
Best for: independent practices with one to ten providers that want denials worked by the same team that files the claims, at a published rate.
2. Neolytix: best for practices that also want payer contracts renegotiated
Neolytix is a Chicago-based RCM company at 318 W Adams St, serving clients from solo practitioners to 45-hospital networks across 40 states. Its denial management sits inside a broader stack that includes coding across 31 specialty pods, credentialing, patient access, and payer contract negotiation. The company states more than 270 healthcare organizations served and over $45 million in monthly A/R under active management.
The contract negotiation service is what separates Neolytix from the rest of this list for a practice with leverage. The company reports an average identified opportunity of $341,000 per contract negotiation and says clients average a 21 percent rate gap below the 75th percentile benchmark. A denial fixed once is worth the claim. A rate corrected once is worth every claim under that contract for the term. If your denials are concentrated with one or two payers, the negotiation conversation is usually the more valuable one.
On denials specifically, Neolytix states same-day denial identification with root-cause coding, multi-level appeals with clinical documentation support, and a 40 percent or greater reduction in denial rates within 90 days of onboarding. It also publishes an unusually direct pricing guide: 4 to 10 percent of net collections as the industry benchmark, 5 to 8 percent as competitive for small and mid-size practices, $3 to $12 per claim for per-claim pricing, and $500 to $2,500 per month for flat-fee arrangements. Setup fees of $500 to $5,000 and credentialing at $150 to $300 per payer per provider are listed as costs buyers commonly miss.
Verify the 40 percent denial reduction claim against your own baseline before it appears in a contract. Ask what denial rate they measured from and on whose data.
Best for: practices whose denials cluster with one or two payers, where renegotiating the contract is worth more than winning the appeals.
3. Rivet: best if you keep billing in house
Rivet is a Utah software company whose Resolve product is built for practices that already have a biller and do not want to hand over the revenue cycle. It gives you customizable denial worklists, batch workflows, root cause identification, and documentation of what was done on each claim. Appeal generation is automated to the extent of filling appeal forms with claim data and populating payer portals through a fill-assist popup, and batch appeals can be exported.
The pricing model is the reason this belongs on a list for small practices. Rivet charges for the software rather than taking a percentage of what it recovers. If you are collecting $500,000 and a contingency vendor takes 25 percent of a $60,000 aged A/R recovery, that is $15,000 for one project. A subscription that your existing biller uses every week has a different shape, and for practices whose denial volume is steady rather than one-time, it usually costs less over two years.
Rivet publishes customer results including one practice recovering $1.2 million in ten months and another moving from roughly 30 appeals a month to about 300 in four days. It states that customers lower their denial rate by 40 percent or more. The company serves solo practitioners through multispecialty groups, plus hospitals and billing consultants, with named specialty support in cardiology, dermatology, and orthopedics.
Software only works if somebody uses it. If your biller is already at capacity and denials are piling up because there is no time rather than no tool, buying software adds a login and solves nothing.
Best for: practices with a competent in-house biller who needs a system for denials rather than a replacement.
4. Waystar: best for AI-generated appeal packages at volume
Waystar, headquartered in Louisville, Kentucky, sells Denial + Appeal Management inside its broader clearinghouse and RCM platform. The product uses generative AI, branded AltitudeAI, to autonomously generate appeal letters and assemble appeal packages, drawing on a library of more than 1,000 prepopulated payer-specific forms. It also uses predictive analytics to prioritize the denials most likely to be overturned, which is the part practices most often get wrong when they work denials oldest-first instead of winnable-first.
Waystar reports a 90 percent reduction in the time to create 100 appeal packages and a 40 percent higher denial overturn rate with AltitudeAI. The workflow is fully paperless with batch appeal submission, and it integrates into the EHR, HIS, or practice management system rather than sitting beside it. Named case studies include Piedmont and Cincinnati Children’s alongside specialty practices, so the platform spans both ends of the market.
The payer-specific form library is the underrated feature. Most small-practice appeals fail on form and process rather than on merit: the wrong appeal form, the wrong address, the wrong level, a missing signature. A library that has already solved that for a thousand payers removes a category of loss that has nothing to do with the strength of your clinical documentation.
Pricing is not published, and the platform is broad enough that you will likely be quoted on more than denials. Ask for the denial and appeal module priced separately so you can compare it against Rivet and against a service.
Best for: practices with enough appeal volume that the bottleneck is packaging and submitting, not deciding what to appeal.
5. Etactics: best for billing teams that live inside appeal letters
Etactics is a revenue cycle software company in Stow, Ohio, with more than 20 years in the market and over 7,000 clients. Its denial product, AppealsPlus, sits alongside intelliClaim for scrubbing and processing, statement services, payment processing, and address validation. The company serves hospital systems, long-term care pharmacies, commercial organizations, and, notably, medical billing companies.
That last client type tells you what Etactics is good at. Billing companies buy tools that handle high letter volume across many payers and many clients without custom setup for each one. If your practice runs its own billing and the daily reality is a queue of denials that each need a letter, a document, and a mailing or portal submission, that is the workflow Etactics is built around.
The platform is broader than denials, which cuts both ways. Buying claim scrubbing, statements, and appeals from one vendor reduces the number of systems your biller signs into, and scrubbing that prevents a denial is worth more than an appeal that wins one. The cost is that you are buying a platform rather than a point solution, and the denial module is unlikely to be sold on its own.
Pricing is not published. Etactics does not state a practice-size floor, which makes it worth a call even for a small office, but ask directly about minimums before you invest time in a demo.
Best for: practices and small billing companies whose appeal volume is high enough to justify a dedicated letter and submission system.
6. Infinx: best for imaging, labs and groups with large A/R inventory
Infinx, based in San Jose, California, combines an A/R and denials platform with managed RCM specialists. The A/R Optimizer module predicts which claims are recoverable and prioritizes work queues accordingly, while Revenue Insights provides dashboards on RCM performance. Human specialists handle the complex cases the automation routes to them. The company states it prioritizes more than 15,000 claims daily and has collected over $8 billion.
Reported results include 20 percent net new collections from A/R and denied claims, a 15 to 20 percent increase in collections, a 15 percent reduction in cost to collect, and a 30 percent reduction in aging A/R. The named provider types are physician groups, radiology networks, cardiology practices, hospitals, ASCs, and imaging centers, which reflects where prior authorization and denial pressure is heaviest.
Here is the part the marketing pages do not lead with. Infinx states a target market of organizations with at least $5 million in net patient revenue and at least $1 million in outstanding A/R inventory, and annual engagements starting at $5,000 per month. A five-provider primary care practice collecting $1.5 million does not meet that floor. If you are in that range, this entry exists so you do not spend two weeks in a sales process that was never going to close.
Best for: imaging centers, labs, and multi-site groups above $5 million in net patient revenue with a large aged A/R inventory.
7. Aspirion: best for complex claims that a normal billing team cannot work
Aspirion is headquartered in Columbus, Georgia, with offices in Alameda, Denver, Lakeland, and Las Vegas. Its business is split between revenue integrity (A/R management, denials management, out-of-network recovery, payment variance recovery) and complex claims: motor vehicle accident, workers’ compensation, Veterans Affairs and TRICARE, and out-of-state Medicaid.
Complex claims are the reason to know this company exists even if you will never hire it. A motor vehicle accident claim involves liability carriers, attorney liens, and subrogation. An out-of-state Medicaid claim requires enrollment in another state’s program before it can be billed at all. These are not denials in the normal sense, and a general billing team will sit on them until the filing window closes because nobody knows the next step. If a meaningful share of your A/R is stuck in those categories, that is a different problem from a high denial rate and it needs a different vendor.
Aspirion reports more than $6 billion in cumulative client recoveries and says clients typically realize 1.5 to 3 times increases in collections. Its denials management solution was rated Best in KLAS in 2024 and 2025, and the company holds HITRUST r2 certification.
The client base is health systems. The site language points at hospitals and large institutions throughout, and pricing is not published. A practice with one to ten providers should read this entry as a description of a problem category rather than a shortlist candidate.
Best for: hospitals and health systems with material A/R in motor vehicle, workers’ compensation, VA, TRICARE, or out-of-state Medicaid claims.
8. Revecore: best for hospitals chasing underpayments
Revecore, headquartered at 6840 Carothers Parkway in Franklin, Tennessee, serves more than 1,300 hospitals across complex claims management, denials management and prevention, underpayment identification and recovery, and A/R management. Its stated client types are large acute care hospitals, health systems, academic medical centers, and integrated delivery networks. Physician practices are not mentioned.
The company reports a 74 percent average success rate overturning denials, 50 percent higher reimbursement on complex claims versus in-house management, and a 70 percent reduction in A/R across complex claim categories. Its approach combines clinical, legal, and AI-powered review, and it launched an AI-native platform, ReClaim, for underpayment recovery and denial appeals.
Pricing is contingency across all solution areas, with fees earned only on cash recovered, no upfront cost, no implementation fee, and no minimum volume threshold. That is the cleanest published pricing posture on this list, and it is worth understanding as a benchmark even though the client profile rules out small practices. Contingency aligns the vendor with recovery, and it is the model to ask about when a smaller firm offers to work your aged A/R as a project.
Underpayments are the category most practices never audit. A claim paid at 60 percent of the contracted rate never appears in a denial report, because it was not denied. If you have never compared a sample of paid claims against your fee schedule, do that before you buy anything on this list.
Best for: acute care hospitals and health systems recovering underpayments and complex denials on contingency.
How to choose a denial management specialist
Decide whether you are buying a service, software, or a one-time recovery project
These are three different purchases and vendors rarely separate them for you. A service means somebody else works your denials every week and you pay a percentage or a monthly fee. Software means your existing biller works denials faster and you pay a subscription. A recovery project means a firm attacks your aged A/R once, usually on contingency, and leaves. Practices that buy software when the real problem is that nobody has time end up with an unused login. Practices that buy a service when the real problem is a coding error in one CPT pay a percentage forever for something a two-hour fix would have solved.
Run this test first: pull your last 90 days of denials and sort by reason code. If three codes account for most of the volume, you have a process problem and you need it fixed at the source. If the denials are scattered across twenty codes and many payers, you have a capacity problem and you need people or a system.
Know your appeal clocks before you sign anything
Medicare fee-for-service gives you 120 days from the date of the initial determination to file a redetermination, and the MAC has 60 days to decide. If that fails, you have 180 days from receipt of the redetermination to request a reconsideration from a Qualified Independent Contractor, which then has 60 days. Level three is an Administrative Law Judge hearing, filed within 60 days of the QIC decision, with a minimum amount in controversy of $200 for 2026. Level four is the Medicare Appeals Council, and level five is federal district court, which for 2026 requires $1,960 in controversy, with claims allowed to be combined to reach it.
One rule inside that sequence matters more than the deadlines and almost nobody outside appeals work knows it. Documentation you do not submit at the QIC reconsideration level may be excluded at every later level unless you can show good cause for leaving it out. Practically, that means the reconsideration is your last unrestricted chance to put the full clinical record in front of a reviewer. A vendor who treats level two as a formality on the way to an ALJ hearing is going to lose winnable cases.
Commercial plans governed by ERISA run on different clocks. The plan must give the claimant at least 180 days to file an internal appeal. The plan then has to decide within 72 hours for urgent care claims, 15 days for pre-service claims, and 30 days for post-service claims, with a possible 15-day extension for circumstances beyond its control.
Understand what changed on January 1, 2026
Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), impacted payers, which include Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid and CHIP managed care plans, and Qualified Health Plan issuers on the federally facilitated exchanges, must now send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests. They must also provide a specific reason for every prior authorization denial, regardless of how the request was submitted, and report prior authorization metrics publicly, with initial reporting due by March 31, 2026. The API requirements follow on January 1, 2027.
The specific-reason requirement is the one to use. A prior authorization denial that arrives with a stated reason is a denial you can answer directly instead of guessing. Ask any vendor how they are logging and categorizing those stated reasons, because that data set is new and the practices that mine it will find their own patterns before their payers publish anything useful.
Ask how aged claims are priced differently from current claims
Aged A/R and current denials are different work with different economics. A 200-day-old claim may be past appeal, may need a reopening rather than an appeal, and may require documentation that nobody can find. A vendor quoting one percentage for everything is either pricing the aged work into your ongoing rate or planning not to do it. Get the aged bucket quoted separately, ideally on contingency, and get a defined end date for that project.
Questions to ask any vendor, and how to hear the answer
Treat the vendor call as a discovery interview rather than a demo. The goal is not to collect claims. It is to find out whether the person on the call has worked a denial recently. Ask open questions, stay quiet after them, and pay attention to whether the answer contains specifics you did not supply.
A real answer names the payer, the service, what the coverage policy required, and what document closed the gap. A scripted answer describes a process and never reaches a specific claim.
A real answer is a short and specific list, sometimes with a caveat that they do not currently work one of your plans. A scripted answer is “all major payers.
Anyone doing this work knows their ratio roughly. Not knowing it means they are resubmitting rather than appealing.
Most vendors stop at level one. The number is either small and honestly stated or it does not exist.
A real answer produces the sample. A scripted answer promises a custom report after onboarding.
Ask for a name and a caseload number.
The most useful question on the list. A vendor who cannot name a loss is either new or not telling you the truth.
Frequently asked questions
It depends on how you buy it. Inside full-service billing, denial work is part of the collections percentage, and the market range Neolytix publishes is 4 to 10 percent of net collections, with 5 to 8 percent competitive for small and mid-size practices. SwiftCare Billing publishes rates from 3 percent. Per-claim pricing runs $3 to $12, and flat monthly fees for small to mid-size practices run $500 to $2,500. Software subscriptions and contingency recovery projects are priced separately. Watch for setup fees of $500 to $5,000 and credentialing at $150 to $300 per payer per provider.
No. Denial management works claims the payer has adjudicated and refused, and it is measured by overturn rate and days to resolution. A/R recovery works everything still outstanding, including claims that were never processed, claims sitting in a payer portal, and patient balances. Most aged A/R projects turn up both, but a vendor who only does A/R follow-up will call payers for status and will not write appeals.
Kodiak Solutions, drawing on data from more than 2,100 hospitals and 300,000 physicians, put the initial denial rate at 11.81 percent of claims in 2024, up 2.4 percent from the prior year. Experian Health’s 2025 State of Claims survey found 41 percent of providers facing denial rates of 10 percent or higher. Premier’s hospital survey found nearly 15 percent of claims to private payers initially denied. Anything under 5 percent is strong performance for a practice. Anything over 10 percent means something specific is broken and is usually findable in a week.
120 days from the date of the initial determination for a redetermination. If that is denied, 180 days from receipt of the redetermination to request a reconsideration from a QIC. Then 60 days to request an ALJ hearing, which for 2026 requires at least $200 in controversy.
For plans governed by ERISA, the plan must allow at least 180 days from receipt of the adverse benefit determination to file an internal appeal. The plan then decides within 72 hours for urgent care claims, 15 days for pre-service claims, and 30 days for post-service claims. Individual payer contracts often set shorter internal deadlines than the regulatory floor, so check the contract as well as the regulation.
Because of the evidence rule. Documentation not submitted at the QIC reconsideration may be excluded from consideration at later levels unless good cause is shown for the omission. If you hold back a clinical note at level two intending to produce it at an ALJ hearing, you may never get to use it.
Yes, and for practices whose billing is otherwise working, it is often the better trade. The arrangement needs clear boundaries: who touches the claim in the practice management system, who talks to the payer, and how corrected claims get routed back so the same error is not repeated on new claims. Without that, you get two teams working the same claim and a payer receiving duplicate submissions.
Root cause fixes on high-volume denial codes show up in 30 to 60 days, because the change happens at claim submission and you see it on the next remittance cycle. Recovery on aged denials is slower and depends on appeal levels: a Medicare redetermination alone can take 60 days for a decision. Treat any promise of a large drop inside the first month as a claim to verify against your own baseline rather than a plan.
The share of claims that pay on first submission without any rework. SwiftCare Billing publishes 98.4 percent clean claims acceptance, and Neolytix states above 96 percent. Above 95 percent is healthy. Below 90 percent means you are funding a rework operation that should not exist. Experian Health found 68 percent of providers say submitting clean claims is harder than it used to be, and named the top causes as missing or inaccurate data (50 percent), authorizations (35 percent), and incomplete patient registration (32 percent).
Some do and some route them back to you. Prior authorization denials often need a peer-to-peer review, which requires your physician rather than a billing specialist. Ask whether the vendor schedules and prepares peer-to-peers or simply notifies you that one is required. KFF found lack of prior authorization or referral accounted for 9 percent of in-network denials among HealthCare.gov insurers in 2023.
A percentage aligns the vendor with collections and costs more as you grow. A flat fee is predictable and costs the vendor nothing extra when a hard claim takes six hours. For denial work specifically, contingency on recovered dollars is the model that most directly matches payment to result, which is why Revecore uses it across every service line. For ongoing billing where denials are one component, a percentage is standard.
Often, and the reason is that so few are ever appealed. KFF’s analysis of 2023 data covering 425 million claims from 175 insurers found HealthCare.gov insurers denied 19 percent of in-network claims and 37 percent of out-of-network claims, with rates ranging from 1 percent to 54 percent across insurers, while consumers appealed roughly 1 percent of denied in-network claims. Payers are not staffed on the assumption that everything will be contested. Before you spend money chasing, check the filing deadline on each bucket, because a claim past its appeal window is a write-off no vendor can recover.
Denial rate by payer and by reason code, overturn rate on appeals filed, average days from denial to resolution, dollars recovered, and the count of appeals filed at each level. If the report shows dollars recovered without showing appeals filed, you cannot tell whether the vendor is winning appeals or just working easy resubmissions.
Reports that show activity rather than outcomes. Appeal counts that never go past level one. A denial rate that stays flat for six months while the vendor reports steady collections, which usually means they are collecting the easy claims and letting the hard ones age. Denial reason codes that disappear from the report without any corresponding process change in your office. And any account manager who cannot tell you, without looking, which payer denies you most.
SwiftCare Billing offers a free financial audit, and a denial-focused version of that review looks at 90 days of remittance advice to identify the denial codes costing you the most, the claims still inside their appeal window, and whether the pattern points at coding, registration, or authorization. It takes about a week and produces a list of claims you can act on whether or not you hire anyone.
