Denial management for ambulatory surgery centers
Approva captures every denial, prepares appeals with the right supporting documentation, and tracks outcomes — so your team spends less time chasing reversed decisions and more time scheduling cases.
Denial capture and root-cause classification
When a payer issues a denial, Approva records the denial reason, classifies it by type — clinical criteria, missing documentation, administrative, or medical necessity — and flags it for the appropriate response. Denial patterns are tracked at the payer and procedure level so your team can see where submissions are failing and address root causes proactively.
Appeal preparation
Approva prepares appeal packages matched to the denial reason. Clinical denials get additional supporting documentation pulled from the chart. Administrative denials get corrected submissions with the specific missing elements. Each appeal is reviewed by a certified specialist before submission — the same review process that runs on initial prior authorization packets.
Peer-to-peer coordination
When an appeal requires direct physician-to-physician review, Approva coordinates the peer-to-peer review — scheduling the call, preparing the clinical brief, and tracking the outcome. Surgeons enter the call with structured documentation rather than pulling charts themselves. Outcomes are recorded against the case for audit and reporting.