As of November 2026, TSI's denial management services work denied insurance claims for hospitals, health systems and physician groups. Denial management is the work of sorting, appealing and following up on denied claims until they pay, then fixing the causes so fewer come back. TSI's specialists sort denials by payer and class, work the highest-value, most winnable claims first, file appeals before payer deadlines and report the root causes behind repeat denials.
Results vary by payer mix and client program.
- Prior authorizationAppeal due in 9 days
- Medical necessityClinical review
- EligibilityCoverage found
- CodingCorrected claim
- Timely filingProof of filing
Missing authorization on outpatient imaging. Fix sent to scheduling.
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
What an unworked denial costs
A denial isn't a loss until you stop working it. The trouble is, working it costs money. Hospitals spent $57.23 in administrative expense fighting each denied claim in 2023, up from $43.84 in 2022, according to a Premier survey of member hospitals and health systems covering 280 hospitals (February 2025).
So the small ones get dropped, and the big clinical ones wait for the one person who knows how to write them.
Meanwhile the deadline runs. Every payer sets an appeal window, and a claim that misses it is gone for good. And if nobody tracks why claims were denied, the same denials come back next month.
What's included
Sorting on arrival
Denials are read and sorted by payer and class: clinical, eligibility and authorization, coding, and technical. Each goes to a specialist who knows that type.
Work in order of value
Claims are ranked by overturn likelihood, dollar value and appeal deadline, so time goes where it returns the most.
Appeals drafted and reviewed
PULSE, TSI's denial and appeals platform, drafts appeal letters from the claim record, the denial reason and the payer's rules. A trained specialist reviews and edits every appeal before it's filed.
Clinical denials
Medical-necessity and level-of-care denials get documentation review and an appeal built on the clinical record.
Follow-up to payment
TSI tracks each appeal through the payer's process and portal until the claim pays or the options run out.
Specialty claims
Workers' compensation, motor vehicle accident and Veterans Affairs claims, with the documents each one needs.
What PULSE has measured
PULSE reads denial letters, ranks claims by overturn likelihood, value and deadline, and assembles a first appeal draft from the claim record. A specialist finishes and files every appeal.
On TSI's own denial work, PULSE has measured an 86% denial overturn rate, 43% higher payment per appeal and 50% less time to appeal. Results vary by payer mix and client program, and outcomes depend on claim age and documentation quality, so the Sprint tests them on your claims against your own baseline.
Where denials come from
Most denials trace back to a step before the claim went out. Sorting them by class shows you which team can stop the next one.
| Denial class | Common causes | Who fixes the cause |
|---|---|---|
| Eligibility and coverage | Inactive coverage, wrong payer, missing coordination of benefits | Registration, with coverage discovery on the back end |
| Authorization | No prior authorization, or one that expired or covers a different service | Scheduling and authorization staff |
| Medical necessity and level of care | Documentation doesn't support the service or the inpatient stay | Clinical documentation and case management |
| Coding | Mismatched codes, missing modifiers, bundling edits | Your coding team or vendor |
| Technical and timely filing | Missing data, duplicate claims, late submission | Billing |
How it runs
Pick the scope
Start with one payer, one denial class or a backlog. TSI can take overflow or the whole inventory.
Connect
Denials arrive through daily files from your Epic or other system, or TSI works inside your system with credentials you issue.
Triage
Denials are sorted, ranked and assigned within your service levels, with deadlines flagged on intake.
Appeal and follow up
Specialists file appeals, call payers and work portals. Every action is logged on the account.
Close the loop
Paid claims close. Lost appeals with patient responsibility move to your self-pay process. Root-cause findings go to your front-end teams.
Where it fits with the other stages
Denial management sits inside the insurance side of the revenue cycle, next to extended business office follow-up on unpaid and aged claims. Run both through TSI and a claim that goes from "no response" to "denied" doesn't change hands.
When the payer's answer is final and a balance shifts to the patient, it moves to early-out self-pay in your name, with the claim history attached. The Healthcare RCM overview shows the full chain.
How to choose a denial management company
Ask each company the same six questions, and ask for the answers in writing:
- Does it sort denials by class and payer, or work one queue in date order?
- Who builds clinical appeals, and how do they use the medical record?
- Will it report overturn rate and paid yield by payer and denial class, against your baseline?
- Can it show you the claim value below which an appeal stops paying?
- Can it work inside your Epic or other system, with credentials you issue?
- Does it send root causes back to the teams that can fix them?
What you see
Dashboards show denial volume and dollars by payer and class, appeals filed, overturn rate, paid yield, days from denial to appeal and to payment, and cost per claim worked. Root-cause reports group denials by the upstream step that caused them, such as registration, authorization or coding.
You'll also see where appeals stop paying. Below some claim value, working a denial costs more than it returns. What a denied claim costs to work shows how to find that line.
General information, current as of November 2026. It isn't legal advice. Rules change and differ by state, so check the sources linked here and talk to your own counsel before you act on it.
The company behind the work
Questions buyers ask
What is denial management in healthcare?
Denial management is the work of sorting, appealing and following up on denied insurance claims until they pay, and TSI's version ranks denials by value and deadline, files reviewed appeals and reports the root causes behind repeat denials.
What is denial management in RCM?
In revenue cycle management, denial management is the back-end step after claim follow-up and before patient billing: working payer denials to payment, then sending a balance to the patient only when the payer's answer is final.
What's the difference between denial management and denial prevention?
Denial management works the claims that were already denied. Denial prevention fixes the upstream steps, such as registration, authorization and documentation, so fewer claims are denied. Good denial management feeds prevention with root-cause reports.
How much does it cost to work a denied claim?
A Premier survey of member hospitals put it at $57.23 per denied claim in 2023, up from $43.84 in 2022. Below some claim value, working a denial costs more than it returns.
Which denials should we outsource first?
Usually the class with the most dollars and the least in-house capacity: often clinical denials or one difficult payer. Start there and compare against your own team.
How does TSI use AI in appeals?
PULSE, TSI's denial and appeals platform, sorts denial letters, ranks claims and drafts appeal letters. A specialist reviews every appeal before it's filed, and outcomes are reported by payer and class.
Can TSI work inside our Epic system?
Yes, with credentials you issue. TSI can also exchange daily files with Epic.
What happens to claims TSI can't overturn?
They close with a reason code. If a balance moves to the patient, it goes to your self-pay process with the full history.
How is denial management priced?
Each engagement is quoted on its own, by denial class and volume. There's no public rate card.
Find out which denials are worth working
The Denials Economics Sprint looks at one payer and one denial class, with defined claim-value bands and a baseline, and reports overturn, paid yield, cash, time, cost per claim and the economic threshold for expanding.
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
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