65% of Denied Claims Are Never Resubmitted: The Revenue Your Practice Is Quietly Giving Away

There is a folder — sometimes physical, sometimes digital — in nearly every dental and medical practice I have consulted with. It contains denied insurance claims. The office manager knows it is there. The billing coordinator adds to it weekly. And nobody has time to systematically work through it.

I asked one practice to audit their denial folder. It contained 127 denied claims from the previous eight months, totaling approximately $94,000 in unpaid charges. When we reviewed the denial reasons, 70% were overturnable — meaning the payer had denied them for reasons the practice could correct and resubmit: incorrect patient information, missing documentation, coding errors, or eligibility issues that had been resolved.

But only 42 of the 127 had been appealed. The other 85 claims — roughly $62,000 — had simply been abandoned. Not because the billing coordinator was lazy or incompetent, but because she was also handling daily claim submissions, patient billing questions, payment posting, and insurance verification. Working the denial folder required uninterrupted time she did not have.

The Denial Epidemic

The numbers on claim denials have gotten worse, not better:

Think about what those numbers mean together. If 12% of claims are denied, 65% of those are never appealed, and 70% of appealed claims are overturned — then practices are voluntarily forfeiting revenue that payers would have paid if someone had simply resubmitted the claim with the correct information.

For a dental practice submitting 800 claims per month, this looks like:

• 96 claims denied (12%)
• 62 claims never resubmitted (65%)
• 43 of those 62 were overturnable (70%)
• At an average claim value of $500, that is $21,500 per month in recoverable revenue that the practice simply gives up.

And the payers know this. As one dental billing specialist put it: “Insurance companies profit from unpaid claims — the more claims they deny, the more cash they keep.” The denial is not always a final answer. It is often a first offer in a negotiation that the practice never enters.

Why Claims Get Denied

The top denial reasons in dental and medical practices fall into predictable categories:

Preventable at scheduling (40-50% of denials):

• Patient not eligible at time of service (coverage cancelled, plan changed)
• Annual maximum exceeded
• Frequency limitation violated (cleaning too soon, x-rays too recent)
• Missing pre-authorization

Preventable at submission (25-30% of denials):

• Incorrect patient demographics (misspelled name, wrong date of birth, wrong subscriber ID)
• Wrong CDT or CPT code
• Missing or incomplete documentation
• Missing signature or date

Requires appeal (20-30% of denials):

• Medical necessity dispute
• Payer disagrees with treatment plan
• Coordination of benefits issue
• Timely filing dispute

The first two categories — 65-80% of all denials — are preventable with pre-appointment verification and pre-submission claim scrubbing. The third category requires an organized appeal process.

The Denial Management Workflow

An effective denial management system has three layers: prevention, detection, and resolution.

Layer 1: Prevention (Stop Denials Before They Happen)

This connects directly to insurance verification automation. If you verify eligibility the evening before the appointment, you catch the 40-50% of denials caused by eligibility issues before the patient even arrives.

Add a pre-submission claim scrub — checking for common errors before the claim is sent — and you catch another 25-30%. Scrubbing checks include: does the patient’s information match what the payer has on file? Is the procedure code valid for the patient’s plan? Are we within the frequency limitation? Is the annual maximum going to be exceeded?

Layer 2: Detection (Know Immediately When a Denial Occurs)

Most practices discover denials when someone posts the ERA (Electronic Remittance Advice) or reads the EOB (Explanation of Benefits). This can be days or weeks after the payer made the decision. During that delay, appeal deadlines are ticking.

Automated detection monitors payer responses and flags denials within hours. Each denial is categorized by reason code, which determines the next action:

• Eligibility denial → Check if patient has updated coverage → Resubmit with corrected information
• Coding denial → Review for correct CDT/CPT code → Resubmit with correction
• Documentation denial → Gather required documentation → Submit appeal with supporting records
• Medical necessity denial → Prepare clinical justification → Submit formal appeal with provider narrative

Layer 3: Resolution (Track Every Denial to Conclusion)

Every denied claim should have one of three outcomes: paid (on appeal), resubmitted (with correction), or written off (with documented justification). No claim should simply disappear into the folder.

The resolution workflow tracks each claim through its lifecycle:

1. Denial detected → Categorized → Appeal or resubmission prepared
2. Appeal submitted → Follow-up calendared for expected response timeframe
3. If payer does not respond within expected timeframe → Escalation reminder
4. If payer denies appeal → Second-level appeal or write-off decision
5. All outcomes logged for pattern analysis

The Timely Filing Trap

Every payer has a deadline for claim submission and appeals — typically 90-180 days from the date of service for initial claims, and 30-60 days from the denial date for appeals. Miss the deadline, and the claim is permanently dead.

This is where the denial folder becomes truly expensive. A claim denied on January 15 with a 60-day appeal window expires on March 16. If nobody reviews the folder until April, that claim is gone — not because it was unappealable, but because the calendar ran out.

Automated deadline tracking eliminates this. Every denied claim gets a calendar entry with alerts at 30 days, 15 days, and 7 days before the appeal deadline expires. The billing coordinator does not need to track deadlines manually — the system surfaces the claims that need attention in order of urgency.

The Revenue Recovery Math

The math on denial management is some of the clearest ROI in healthcare operations:

A two-provider dental practice submitting 800 claims per month with a 12% denial rate generates 96 denied claims monthly. If the practice currently appeals 35% (industry average) and starts appealing 80% with an automated system:

• Current recovery: 34 claims appealed × 70% overturn rate × $500 average = $11,900/month
• Automated recovery: 77 claims appealed × 70% overturn rate × $500 average = $26,950/month
• Incremental revenue: $15,050/month = $180,600/year

That is not a theoretical exercise. That is revenue the practice already earned — the work was already done, the patient was already treated — but is being voluntarily forfeited because nobody has time to manage the follow-up.

The denial folder does not need to be a graveyard. It needs to be a workflow.