Claims Appeals & Disputes

Denied or underpaid claims are not a billing problem. They are a legal one, governed by contract terms, ERISA, federal regulations, and state prompt-pay law. The firm's in-house auditing capability lets us reconstruct the claim and the appeal in the same workflow.

First and second-level appeals

We draft appeal letters that engage the actual basis for the denial, medical necessity, coding, bundling, timely filing, coordination of benefits, and that build the administrative record needed if the matter escalates.

ALJ, external review, and federal court

When administrative appeals are exhausted, we represent providers at Administrative Law Judge hearings, in independent external reviews, and in federal court for ERISA and breach-of-contract claims.

Pattern denials

Where a payor is denying a category of claims at scale, we represent the provider in coordinated appeals and, where appropriate, in litigation that addresses the underlying pattern rather than the individual claim.