Fertility Claim Denial Management:
Root-Cause Analysis & Appeals
Most denial management is reactive — rework the claim, resubmit, repeat. We take a root-cause approach: identify why denials are happening and fix the upstream process so they stop recurring.
Book a Free Audit →Top Denial Reasons in Fertility Billing
Approximate distribution based on EasyRCM internal data. Your practice's mix will vary by payer and specialty.
Root-Cause Analysis
Every denial is categorized by payer, code, and reason. Monthly reports show trends — so we can see when a single payer change is driving a spike.
Payer-Specific Appeals
Appeals are written with the specific language and documentation each payer responds to — not a generic template.
Process Fix Loop
When a denial pattern is identified, we trace it to the source — scheduling, eligibility, auth, or coding — and work with your team to fix it.
Common Questions About Fertility Denial Management
What is the most common denial reason for IVF claims?
Authorization-related denials account for approximately 28% of fertility claim denials — either missing, expired, or mismatched authorization numbers. The second most common reason is coverage-related: the service was billed to a benefit that does not cover it, or the patient's plan changed mid-cycle.
How long does a fertility claim appeal take?
Most commercial payers have 30–60 day review windows for formal appeals. Peer-to-peer reviews for prior auth denials typically occur within 7–14 days of request. Timelines vary significantly by payer — some fertility benefit managers have shorter windows, so we initiate appeals immediately upon denial.
How do you prevent denials rather than just reworking them?
We categorize every denial by root cause — authorization, eligibility, coding, or documentation. When a pattern emerges (e.g., a specific payer consistently denying a code combination), we trace it to the source and work with your scheduling, eligibility, or clinical teams to fix the upstream process.
Do you track denial rates by payer and procedure?
Yes. Monthly reporting breaks denial rates down by payer, CPT code category, and denial reason. This visibility lets us identify when a single payer change is driving a spike — and address it before it compounds.
How much revenue is sitting in denied claims?
Our free audit reviews your denial rate, top denial reasons, and recovery potential — with actionable next steps.
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