There's Denial Management. Then There's Reimbursement Defense.
Other companies promise to "manage your denials" and take work off your hands. We put the power back in your hands. We are a Reimbursement Defense Resource giving your team the frameworks, strategies, and regulatory leverage needed to challenge unfair denials, underpayments, and recoupments, making powerful reimbursement defense accessible to every small practice and independent biller.
No training or learning curve needed. You don't need to become a reimbursement expert. You simply need access to the right appeal strategy and escalation path when the problem arises. That's exactly what MCA provides.
We help:
- Solo and small practices that want to stay independent and profitable,
- In-house billers and small RCM teams who are tired of write-offs and canned appeal letters that don't work, and
- Specialty practices (chiro, PT, surgery, behavioral health, etc.) facing chronic denials and recoupments.
How We're Different
Traditional denial management vendors play an important role in helping practices prevent and resolve routine denials through billing corrections, workflow improvements, claim follow-up, and revenue cycle management. Their primary focus is often on operational issues that contribute to denials and delays in payment.
MCA serves a different purpose. As a Reimbursement Defense Resource, we help providers and billers identify and challenge payer tactics that lead to hard denials, underpayments, recoupments, and other complex reimbursement disputes. While we can handle denials and reimbursement disputes on your behalf when needed, our primary mission is to equip your team with the strategies, appeal letters, regulatory leverage, and escalation pathways needed to fight back effectively and with confidence. This approach not only helps your practice build valuable reimbursement defense capabilities, but also allows you to retain most of your recovered revenue rather than giving a large percentage of every recovery to a third-party vendor.
While most denial management companies use the law and regulations lightly, leaning heavily on policy bulletins and internal guidelines, MCA emphasizes a deep focus on governing plan documents, ERISA claims procedures, government program rules, state protections, and, when needed, escalation through plan sponsors, executive-level payer complaints, government oversight channels, and departments of insurance.
Core Products and Services
You can engage MCA on two levels: Do-it-yourself using our case-specific strategies and tools, or utilize our done-for-you revenue recovery.
When a typical denial, underpayment, or recoupment needs expert assistance, you can engage us on a case-by-case basis.
Each case includes:
- Review of the denial or underpayment, including EOBs, plan and policy language, and prior correspondence (if any).
- Identification of the root issue and the payer's denial/underpayment tactic.
- Tailored appeal drafting, including plan and regulatory arguments, not generic "please reconsider" letters.
- Strategy and letter drafting for follow-up and escalation if needed, including plan sponsor or payer CEO engagement, and regulatory complaints where appropriate.
We treat each case as a revenue recovery project, not just an "appeal letter."
Pricing and Service Levels
Case-based pricing is calibrated to claim value and complexity so that smaller practices are protected, and high-value claims get the depth they require.
A case is one denial or underpayment scenario, and all related work required to address that issue, including follow-up appeals and escalation. When the denial or underpayment is finally resolved, you then have the right appeal template and strategy to use on any future claims for the same type of denial/underpayment.
Pricing Ranges
- Standard Case.....$99 - $595 (Includes most denials and underpayments)
- Complex Case....$595 - $1,495 (May include any of the following: high-dollar issues, multiple appeals or disputes, extensive documentation reviews, multiple related claims, significant plan interpretation issues, multiple payer departments involved, escalations, and regulatory complaints)
- Exceptional Matters....Custom Quote
Some cases may require only a single appeal, while others require multiple follow-up appeals, escalation efforts, and extensive payer correspondence. Our pricing is designed to reflect the value and complexity of each dispute while remaining fair to practices of all sizes. Each case starts with a case initiation fee of $99 - $595 (depending on the amount in dispute and case complexity), then additional fees apply only if further appeals, escalation, or advanced case work are authorized. High-value complex cases ($50,000+ at issue) may include a 5% recovery success fee.
First-Time Client Special: $99 for one case, regardless of the claim value and complexity. High-value complex cases may still include a 5% recovery success fee.
Client Protection Policy
Not every denial or underpayment should be pursued indefinitely. In some cases, it may not become apparent until after the initial appeal response that further action is unlikely to produce a meaningful recovery or would not be financially justified based on the circumstances of the case.
To protect our client's financial interest, if we determine after the initial review and appeal that no further action is recommended, your fee will be capped at our case initiation fee. This covers our initial analysis, strategy development, and appeal preparation. We believe providers should have access to an honest assessment of their options without paying for unnecessary follow-up work that is unlikely to benefit them.
Done-For-You Revenue Recovery: If you want to hand the fight off entirely, we can provide you with full recovery services. No upfront fee, and we charge a contingency of 25% of what we recover. No recovery, no fees.
Free Reimbursement Defense Assessment
Before you decide whether to invest time, money, or energy into a difficult claim, you should know if it's actually worth the fight. That's exactly what our Free Reimbursement Defense Assessment is designed to do.
You send us the basics: EOB, the denial reason or underpayment explanation, and any brief context you have, and we'll take a focused look at the issue. After reviewing the materials, we'll tell you whether the case is worth pursuing, what payer tactic appears to be in play, and the realistic recovery potential. You'll also get a clear practical recommendation for your next step, whether that's a full case engagement, tackling it yourself using our frameworks and targeted appeals, or deciding it's not worth further effort. This way, you may make informed decisions on tough claims without any upfront cost or pressure.
Act Now
If you're facing a complex denial or underpayment, which may even affect multiple claims, and you're not sure where to start, send it over, and let's treat it as a single structured case. We'll review the full issue, identify the root problem, and outline a clear appeal and escalation strategy that will get you paid.
Click here to submit your case details, and we'll follow up with a confirmed price and next steps before any work begins.
