When Insurance Companies Deny Payment...
We resolve difficult medical claim denials and build case-specific appeals for independent physician practices, outpatient specialty groups, healthcare organizations, and medical billing and RCM companies.
Your viable denials deserve more than a form letter. We investigate the denial, claim history, payer requirements, and supporting documentation to determine the strongest available resolution path and build each appeal around the facts of the case.
We Appeal, We Push Back, and We Pursue What You’re Owed.
Revenue Recovery
Denied claims consume time long after routine billing follow-up stops being productive. Independent physician practices, outpatient healthcare organizations, and medical billing and RCM teams turn to us when difficult claims require deeper research, documentation review, payer follow-up, and appeal development.
We dedicate the time and reimbursement expertise needed to determine why a claim was denied, identify the appropriate resolution path, and build well-supported, case-specific appeals when an appeal is warranted. Don’t let viable claims disappear into the backlog.
A difficult denial should not be written off simply because resolving it takes more time than your existing workflow can absorb. We pursue defensible claims with careful research, persistent follow-up, and close attention to filing deadlines so your team has a meaningful opportunity to recover reimbursement for care already provided.
How It Works
1. Tell us what is stuck.
Tell us about the denied claims, aging accounts, backlog, or revenue-cycle work your team does not have the time or resources to pursue. For larger inventories, you can provide the reports or worklists you already use rather than reorganizing the accounts for us. Once secure access and the necessary agreements are in place, we work within your existing practice management system, EHR, and payer portals whenever practical. No major workflow overhaul is required.
2. We research, resolve, and track each case.
Each claim is reviewed individually to determine why it was denied and what resolution pathway is appropriate. When an appeal or reconsideration is warranted, we evaluate the claim history, medical documentation, payer-specific adjudication basis, and applicable authoritative criteria available for the case. We develop case-specific work rather than generic form letters and track the account through the agreed scope of service.
3. We recover your revenue.
We complete the agreed resolution work, and submit appeals or other authorized requests when appropriate. You receive clear documentation of what was done, what remains outstanding, and what should happen next. Our goal is to help viable claims move toward appropriate reimbursement while giving your team a defensible disposition for accounts that require another resolution path.
Why Choose Oravi Consulting
Strong appeals require more than knowing how to write an appeal letter. They require understanding why the claim failed in the first place. That’s our standard.
Our work draws on experience across clinical operations, medical billing, coding-related claim analysis, payer processes, credentialing, and enrollment. That broader revenue-cycle perspective helps us look beyond the denial code, identify the underlying reimbursement issue, and determine the most appropriate path toward resolution.
When an appeal is warranted, we build it around the individual case. We examine the denial rationale, claim history, payer-specific requirements, and available clinical and billing documentation to develop a well-supported argument rather than relying on generic form letters.
We are especially experienced with medical-necessity and prior-authorization appeals, laboratory and ancillary billing issues, CLIA and reference-lab denials, coding and modifier-related reimbursement issues, and denials connected to provider credentialing or payer enrollment.
Client information is handled through controlled healthcare workflows, with appropriate Business Associate Agreements, secure access practices, and administrative and technical safeguards designed to protect PHI.
We support independent physician practices, outpatient specialty groups, medical billing and RCM companies, and other healthcare organizations when complex claim denials, credentialing issues, or payer enrollment problems require more time, research, or specialized attention than routine internal workflows can reasonably absorb.
Our work spans commercial insurance, Medicare, Medicaid, Medicare Advantage, and other government and managed-care payers, with each account evaluated according to its individual denial reason, payer requirements, documentation, and reimbursement circumstances.
Who We Work With
Our clinical and revenue-cycle experience is especially well suited to organizations such as:
Outpatient rehabilitation and physical therapy practices
Orthopedic and sports medicine practices
Pain management and PM&R practices
Rheumatology practices
Gastroenterology practices
Cardiology practices
Oncology and hematology practices
Dermatology practices
Primary care and internal medicine practices
Practices with in-house laboratory, diagnostic, or ancillary services
Medical billing and revenue cycle management companies supporting these and other specialties
Even if your organization type isn’t listed, if you have difficult denials or reimbursement issues that require deeper review, we can evaluate the work and determine whether it fits our scope.