Managed Care Resolution Services: It should be getting better. For many providers, it feels worse than ever.
Over the past several years, CMS has added important guardrails intended to bring more accountability and consistency to managed care. Providers expected that to make the landscape easier to navigate.
Instead, many are finding the opposite.
Denials still feel inconsistent. Prior authorization requirements still create delays and frustration. Requirements vary from plan to plan. And provider teams are left spending more time, more energy, and more resources trying to manage a process that feels anything but predictable.
If your organization is feeling that pressure, you are not alone.
Why managed care still feels so difficult
The challenge is not just that denials happen. It is that they happen in ways that often feel inconsistent, time-consuming, and difficult to challenge.
Medicare Advantage now covers a majority of eligible Medicare beneficiaries, which means more providers are dealing with plan-driven utilization management, authorization requirements, and appeals activity as a routine part of operations.
At the same time, many providers are facing a second problem: even when denials are questionable, internal teams often do not have the time or bandwidth to keep fighting them. And yet many appealed denials are overturned when the appeal is actually made.
That is the gap Celtic is built to help address.
Managed Care Resolution Services from Celtic
Celtic’s Managed Care Resolution Services are designed to help providers manage the growing operational and financial burden of managed care in a practical, done-for-you way.
This is not about giving your team more guidance, more homework, or more workarounds.
It is about taking work off your plate.
Under the guidance of Maureen McCarthy, Celtic helps providers respond to denials, manage appeals, and add case management capacity in ways that reduce internal strain and support stronger reimbursement outcomes.
Three ways to work with Celtic
1. Send us your toughest denial
Have a denial your team is stuck on?
Send it to Celtic.
We review the denial, identify the strongest path forward, build the appeal strategy, and manage the process on your behalf. This is a simple, low-risk way to get started and see the results we can deliver.
This option is a strong fit if:
- your team is stuck on a denial that is not moving
- you are not getting traction with the plan
- you do not want to commit to a larger engagement yet
- you want an expert team to step in and take it from there
2. Turn over your denials and appeals process
For some organizations, the issue is not one denial. It is the ongoing burden.
If denials are piling up, staff are stretched thin, and reimbursement is being delayed or lost, Celtic can step in and manage your denials and appeals process from start to finish.
We work as an extension of your organization, taking ownership of the process so your team can stay focused on patient care, operations, and the many other priorities already competing for their attention.
This option is a strong fit if:
- denials are becoming a regular operational problem
- your staff does not have the bandwidth to keep up
- you want a partner who can manage the work, not just advise on it
- you need a more consistent, experienced approach to appeals
3. Add case management capacity without growing your team
In today’s environment, many providers also need more capacity around case management, but do not have the ability to grow internally.
Celtic can step in as an outsourced case management resource, helping reduce pressure on internal teams while keeping important work moving.
This option is designed for organizations that need experienced support without adding another full-time role. It is a practical way to strengthen coverage, reduce strain, and support better overall managed care performance.
This option is a strong fit if:
- your team is stretched thin
- case management demands are growing
- you need additional operational capacity
- you want outside expertise without growing your team
Why Celtic
What makes Celtic different is not just the expertise behind the work. It is the way the work is delivered.
Celtic’s Founder & CEO, Maureen McCarthy, has spent decades advocating for providers and beneficiaries in the managed care space and was directly involved in the policy discussions that shaped recent CMS Medicare Advantage rule changes.
She knows the disconnect many providers are feeling between the requirements of recent years’ Medicare Advantage Final Rules versus what is still happening in the market.
Under her guidance, Celtic brings providers a team that understands:
- what rules apply
- how plans are interpreting them
- what citations matter
- how to structure appeals effectively
- how to step in and reduce burden on internal staff
We do not hand the work back to your team.
We take it off your plate.
Start with one denial
If your team is feeling overwhelmed by denials, appeals, or growing case management demands, Celtic is ready to help.
Start with one denial.
Turn over the process.
Add case management capacity without growing your team.
Prefer to talk directly?
Tell us what your team is facing, and we will follow up. Contact us at consultant@celticconsulting.org.
