A claim came back denied. What do I do?
A denial is not a dead end. It is the payer telling you what to fix, written in code.
Denied claims do not hide. Filter the claims list to Denied and every one wears a red badge. Open one and you get the whole story: the status, the amount at risk, and a red banner with the reason as a code, with plain English beside it.
Every denial falls into one of three buckets, and naming the bucket is the first decision:
- Fix and resend. Something was missing or wrong. Add it and send a corrected claim. Missing information denials are this friendly kind.
- Appeal, with proof attached. The payer’s decision is arguable and you have documentation that supports the service.
- Write it off. A few genuinely cannot be recovered. Stopping is a decision, and it is recorded as one.
Work the amount at risk, not the row count. A denial worth 760 dollars deserves your morning more than three worth 20.
Two things make this faster. The reason is already decoded for you, so you are never staring at a bare code. And you can ask the claim itself why it was denied, and get an answer grounded in that claim rather than a general article. See How do I find out why a claim was really denied?.