Capture MoneyRecover revenue already earned
Denial Management gives your billing team a structured workflow for tracking, categorizing, and resolving claim denials. Instead of denials quietly aging out in a clearinghouse or EOB pile, CareIncite surfaces them with the denial reason and recommended next steps so your team can act while the appeal window is still open.
Why denials matter more than you think
The average behavioral health practice has a denial rate between 5% and 15%. Most practices accept this as a cost of doing business. But the majority of denied claims are recoverable — if caught and appealed in time. The problem is not that denials happen. The problem is that they go unworked.
A denied claim has a limited appeal window (typically 30–90 days depending on the payer). Without a system to surface and track denials, many expire before anyone looks at them. Denial Management ensures that every denied claim is visible, assigned, and tracked to resolution.
The denial workflow
CareIncite processes denials through a four-stage workflow:
1. Detection
Denied claims are identified from remittance data (ERA/EOB) or flagged during the billing reconciliation process. Each denial is logged with the claim details, denial reason code, payer, client, and date of service.
2. Categorization
CareIncite categorizes each denial by reason: eligibility-related, authorization-related, coding error, duplicate claim, timely filing, or other. This categorization drives the recommended action and helps identify systemic patterns.
3. Resolution
Your team works each denial: correcting the claim and resubmitting, filing a formal appeal, or writing off the claim if it is truly unrecoverable. CareIncite tracks the status of each denial through resolution.
4. Analysis
Over time, CareIncite builds a denial history that reveals patterns. You can see which denial reasons are most common, which payers have the highest denial rates, and whether your denial rate is trending up or down. This data drives process improvements that reduce future denials.
Common denial reasons
Eligibility— Client was not eligible on the date of service. Most common and most preventable with Eligibility Watchdog.
Authorization— No valid prior authorization, exceeded authorized units, or authorization expired before date of service.
Coding— Invalid or mismatched CPT/HCPCS code, modifier error, or diagnosis code not supporting the billed service.
Duplicate— Claim was already submitted and processed. Usually caused by re-import or system error.
Timely filing— Claim was submitted after the payer's filing deadline. These are typically unrecoverable and represent a pure process failure.
Relationship to other Capture Money features
Denial Management works alongside the other Capture Money features to form a complete revenue protection pipeline. Eligibility Watchdog prevents eligibility-related denials by catching lapses before sessions happen. Sessions At Risk flags potentially unbillable sessions before they are submitted. Denial Management handles the claims that still get denied despite these preventive measures. And Per-Payer Reconciliation verifies that approved claims are actually paid at the expected rate.
Revenue Impact
Practices that systematically work their denials recover 40–65% of initially denied revenue. Without a denial management workflow, the recovery rate is typically below 10% because most denials simply expire unworked. The goal is not zero denials — it is zero unworked denials.
