Reimbursement & Resolution
Denials & Appeals
Denials require ownership, deadlines, documentation, payer follow-up, and a clear path to resolution. Ellery Health Partners administers that path: denial research, reconsideration and appeal administration, deadline tracking, payer follow-up, and root-cause reporting.
Overview
A denial is a payer decision with a reason, a deadline, and a defined path to challenge it. Administrative denials, those arising from authorization, eligibility, referral, timely filing, coordination of benefits, or credentialing and enrollment, have a defined path to reconsideration or appeal when the reason is identified and the response is complete and on time. Denials that go unworked become write-offs; denials that recur point to a fixable upstream problem.
Ellery Health Partners researches and categorizes each denial, investigates timely-filing and coordination-of-benefits issues, coordinates medical-record requests, and prepares reconsiderations and first-level appeals, with additional administrative appeal levels where scoped. Appeal packets are assembled from the supporting documents the practice provides, submitted through the payer’s process, and followed to a documented outcome, with deadlines tracked throughout. Where a payer offers a peer-to-peer review, Ellery Health Partners prepares the administrative file for the treating provider; scheduling and tracking are handled under Prior Authorization. Denial trends and root causes are reported so that repeat administrative denials can be reduced at the source.
What Ellery Health Partners handles
Denial research
- Denial-reason research and denial categorization
- Authorization-related, eligibility and coverage, referral-related, and administrative or documentation denials
- Timely-filing investigation
- Coordination-of-benefits and credentialing or enrollment-related denials
- Medical-record request coordination
- Root-cause identification and denial trend reporting
Appeals and escalation
- Reconsiderations and first-level appeals
- Additional administrative appeal levels where scoped
- Appeal packet assembly and supporting-document coordination
- Appeal submission, appeal status follow-up, and payer escalation
- Corrected-claim coordination
- Administrative preparation for peer-to-peer reviews, which are scheduled and tracked under Prior Authorization
- Appeal deadline tracking and outcome documentation
Where it sits in payer operations
Denials and appeals draw on the authorization, eligibility, referral, and claims record, and the findings feed back into those workflows.
Within your existing systems
Ellery Health Partners performs this work inside the systems your practice authorizes for the assigned workflow: the EHR or practice-management system, payer portals, pharmacy benefit manager and specialty-pharmacy platforms, clearinghouses, CAQH and PECOS, and the payer telephone channels the work requires.
Your practice provisions the accounts, sets the permissions, and can modify or revoke access at any time. Nothing is moved into a separate Ellery Health Partners patient database.
Reporting and accountability
Ellery documents payer activity within the practice-approved systems used for the engagement, with supplemental operational tracking where appropriate. That tracking is aggregate and contains no protected health information; patient-level case detail stays in your systems.
Reporting appropriate to the engagement covers case status, last payer action, next follow-up, deadlines, determinations, unresolved issues and escalations, and the administrative barriers that recur.
Service boundaries
Ellery Health Partners assembles, submits, tracks, and documents.
Clinical responsibilities remain with the practice
Ellery manages the administrative denial and appeal workflow, including denial research, documentation coordination, deadline tracking, reconsideration and appeal administration, payer follow-up, and escalation.
Medical-necessity determinations, treatment decisions, peer-to-peer clinical discussions, and other clinical judgments remain with the appropriate licensed treating provider.
When work is scoped separately
Formal appeal work is scoped in writing, separately from Payer Desk capacity. Scoped separately from routine appeal administration:
- Second-level and external administrative appeal levels
- Denial backlogs across a defined date range
- Payer-specific denial projects
- Root-cause review projects across a payer, denial category, or date range
Specialties where this work is concentrated
Get started with Ellery Health Partners
Tell us about your practice, your approximate monthly volume, and the support you need. We review your workflow, confirm the scope, and send the agreement and onboarding documents. No patient information is requested or accepted.