Soft denials
The payer wants something fixed, such as a missing modifier, a wrong member ID, or an authorization number that did not attach. These can be corrected and resubmitted without a formal appeal, as long as someone gets to them quickly.
Denial management services for independent practices
Denial management is the work of finding out why a payer refused a claim, fixing what can be fixed, and appealing the rest. Taiga does that work for independent practices as part of end-to-end billing. Every claim is scrubbed against current payer rules before it goes out. Most soft denials are corrected and resubmitted within 48 to 72 hours of the remittance hitting our system, and hard denials enter the appeal queue the same day.
Book a demoThree kinds of denials, three different jobs
A denial is not one task. Each kind needs a different response, and the cheap ones are the easiest to lose.
Hard denials
The payer says no until you show otherwise. These need a written appeal with the right documentation from the encounter, in the format that payer expects.
Small-dollar denials
When every appeal takes staff time, a small underpayment gets written off because spending more to recover $50 does not make sense. Over time, that leakage compounds.
How Taiga runs denial management
AI drafts the work and an experienced billing team runs it. Your physicians stay in the loop on coding.
Before the claim goes out
Every claim is scrubbed against current payer rules before submission. Eligibility is verified in real time, modifiers and authorizations are checked, and fee schedules are validated, so problems get caught upstream instead of after the fact.
Coding with physician sign-off
Taiga drafts ICD-10 and CPT codes from your clinical notes. The doctor of record reviews and approves before anything is submitted.
Soft denials
Most soft denials are corrected and resubmitted within 48 to 72 hours of the remittance hitting Taiga's system.
Hard denials
Hard denials enter the appeal queue the same day, with payer-specific letter templates and supporting documentation pulled from the encounter.
Small-dollar denials
The appeal workflow is automated, so a $40 denial gets appealed as systematically as a $4,000 one. Nothing ages out because nobody had time.
Visibility
Your dashboard shows live collections, denials, days in A/R, and payer performance. Drill into any claim to see its status.
What is changing with payers
Payers are automating their side of the claim, and new federal rules change how prior authorization works. Here is what recent reports say, and what each change means for a practice without a billing department.
More groups are automating
In an Oct. 20, 2026 MGMA Stat poll, 63% of 214 responding medical group leaders said their revenue cycle is leaning toward more automation. Another 26% expected no major change, and 11% said they were shifting toward more manual work. (MGMA, Oct. 21, 2026)
What it means for your practice
MGMA notes that payers increasingly use automation to review claims, while provider organizations often lack the capacity to scrutinize those decisions at the same speed. Denials that wait in a manual queue fall further behind.
Medicare Advantage downcoding
MGMA says automatic downcoding by Medicare Advantage plans is the fastest-growing complaint it hears from members, and that many practices do not know a plan has placed them under such a policy. (MGMA, Oct. 21, 2026)
What it means for your practice
Downcoding can go unnoticed unless you compare the codes you submitted with the codes you were paid on the same claim. MGMA suggests keeping a payer-by-payer log of denials on approved authorizations and downcoded claims as evidence for contract talks.
Prior authorization keeps growing
In MGMA's 2026 Regulatory Burden Report, 90% of practices said their prior authorization burden grew over the previous 12 months. (MGMA, Oct. 21, 2026; Physicians Practice, Oct. 27, 2026)
What it means for your practice
An approval does not always end the work. At an MGMA town hall, an oncology practice leader described claims denied even with an approved authorization. Taiga checks authorizations on every claim before it goes out, so a missing authorization number is caught before the payer sees the claim.
Decision deadlines and denial reasons
Under the CMS Interoperability and Prior Authorization final rule (CMS-0057-F), impacted payers must, generally since January 1, 2026, send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests, and give a specific reason when they deny one. Plans on the federal exchanges are excluded from the decision timeframes, and the rule does not cover drugs. (CMS fact sheet, CMS-0057-F)
What it means for your practice
A specific denial reason tells your team exactly what to fix before resubmitting the request, instead of guessing. Keep a record when a covered plan misses these timeframes or denies without a reason.
Prior authorization APIs in 2027
The same rule requires impacted payers, which include Medicare Advantage plans, Medicaid and CHIP programs and plans, and plans on the federal exchanges, to offer a Prior Authorization API, generally beginning January 1, 2027. Exact compliance dates vary by payer type. (CMS fact sheet, CMS-0057-F)
What it means for your practice
The API lets a system ask a payer which services need approval and what documentation it wants, then get the decision back electronically. MGMA staff found few members they asked had heard from their EHR vendor about it, and suggests asking your EHR and practice management vendors which payers' APIs will connect to your system, when, and at what cost.
Common reasons claims get denied
Payers check every claim against plan-specific rules. Miss a modifier, an authorization, or a documentation signal, and a simple claim can drop into manual review or come back denied. These guides go deeper.
What causes claim denials? The 7 most common reasonsThe causes that show up most often, and how to prevent each one.Why claims fail first passHow payer AI reviews claims, and what gets a clean claim through on the first try.Denial management in medical billing: a step-by-step frameworkA step-by-step way to sort, correct, and appeal denials.Why small denials compoundWhy small write-offs add up, and how to stop the leak.
Claims a payer left unpaid, recovered
Neal Cheskis, LCSW, runs Cheskis Family Therapy on his own. Taiga took over his billing, including claims a single payer had left unpaid.
- Previously unpaid Horizon BCBSNJ revenue recovered
- $3.7K+
- Previously unpaid Horizon BCBSNJ revenue recovered
- Denials among adjudicated claims, July 16 to August 15
- 0%
- Denials among adjudicated claims, July 16 to August 15
- Average from submission to payment
- 8.3 days
- Average from submission to payment
Switching and pricing
Open denials do not have to wait for a clean start. Taiga picks up where your current biller leaves off.
Open denials and claims in flight
Taiga can run in parallel for a transition period or take over open A/R from your current biller, depending on what your contract allows. Either way, no claim falls through during the handoff.
Keep your EHR
Clinicians keep charting in the EHR they use today. The only new step is a quick code approval for the doctor inside their existing workflow.
Two weeks to first claim
Taiga's implementation team handles the EHR connection, payer enrollment, and historical data migration without pulling staff off patient care.
Pricing
A percentage of what Taiga collects, set by your practice's annual revenue: 6.5% up to $2M, sliding toward 4% as revenue approaches $10M, and a custom rate from $10M. No setup fees, no per-claim charges, and no surprise add-ons.
Who this fits
Independent practices from solo providers up through ten-provider groups, including practices with more than one office. Denial management is part of Taiga's end-to-end billing service. Groups above ten providers get a custom scope.
Scope note
Taiga does not serve hospital-owned practices or large health systems. Published specialty support covers primary care, internal medicine, pediatrics, cardiology, orthopedics, and mental health. For anything else, bring your service mix and Taiga will tell you straight.
Questions about denial management
What is denial management?
Denial management is the work of tracking why payers deny claims, correcting and resubmitting the ones that can be fixed, appealing the rest, and catching the causes upstream so fewer claims get denied. Taiga handles it as part of end-to-end billing for independent practices.
What is the difference between a soft denial and a hard denial?
A soft denial can be corrected and resubmitted, for example when a modifier is missing or a member ID is wrong. A hard denial needs a formal appeal with supporting documentation. Taiga resubmits most soft denials within 48 to 72 hours and puts hard denials in the appeal queue the same day.
How fast does Taiga work denials?
Most soft denials are corrected and resubmitted within 48 to 72 hours of the remittance hitting Taiga's system. Hard denials enter the appeal queue the same day, with payer-specific letter templates and supporting documentation pulled directly from the encounter.
Do you appeal small-dollar denials?
Yes. Taiga automates the appeal workflow so a $40 denial gets appealed as systematically as a $4,000 one.
How do you prevent denials in the first place?
Every claim is scrubbed against current payer rules before submission. Eligibility is verified in real time, modifiers and authorizations are checked, and fee schedules are validated. Denials get caught upstream instead of after the fact.
What changes for prior authorization in 2027?
Under the CMS Interoperability and Prior Authorization final rule, impacted payers, including Medicare Advantage plans, Medicaid and CHIP, and plans on the federal exchanges, must generally offer a Prior Authorization API beginning January 1, 2027, with exact dates varying by payer type. The API can show which services need approval and what documentation the payer wants, and return the decision electronically. Ask your EHR vendor which payers will connect to your system and when.
Can you take over open denials from our current biller?
Yes. Taiga can run in parallel for a transition period or take over open A/R from your current biller, depending on what your contract allows. Either way, no claim falls through during the handoff.
What does denial management cost?
Denial management is part of Taiga's billing service, priced as a percentage of what Taiga collects: 6.5% up to $2M in annual revenue, sliding toward 4% as you approach $10M, and a custom rate from $10M. There are no setup fees or per-claim charges. If Taiga does not collect, you do not pay.
Find out where your denials are going
Bring your payer mix, your EHR, and a recent denial report if you have one. Taiga will tell you straight where it can help, and where it cannot.