Pre-submission risk scoring
Every claim checked for denial risk before it leaves — fixes applied up front.
Services / Denial Management
Denial Management
Most denial management starts after the denial — which means the revenue is already stalled. GetMax scores every claim for denial risk before it's submitted and fixes the cause up front. When denials do land, they're appealed fast with payer-specific arguments, and the root cause is fed back so the same denial doesn't happen twice.
What's included
Denial triage & routing
Incoming denials categorized by CARC code and routed for action immediately.
Appeals & reconsiderations
Payer-specific appeal letters built from documentation, filed on time.
Root-cause prevention
Recurring denial patterns traced to source and fixed in the workflow.
Denial analytics
Denial rates, reasons, and recovery visible by payer and provider.
How it works
- 01
Predict
Claims scored against payer behavior before submission; risky ones fixed first.
- 02
Fight
Denials triaged and appealed with documentation-backed, payer-specific arguments.
- 03
Prevent
Every denial's cause feeds back into coding and billing rules upstream.
Questions, answered
Do you appeal every denial?+
Every appealable one. Denials are triaged by recoverability and value; winnable claims are appealed with documentation-backed arguments, and unwinnable patterns are fixed at the source instead.
Which denial types do you handle?+
The full CARC range — from missing-information (CO-16) and timely filing (CO-29) to bundling (CO-97) and medical-necessity (CO-50) denials, each with its own resolution path.
How is this different from normal denial follow-up?+
Prediction. Traditional denial management reacts after revenue stalls; GetMax scores risk before submission, so a large share of denials simply never happen.