Denial Follow-up
Start with the payer’s stated reason for a denial. Bring the explanation, claim details and missing-information questions together before the billing team chooses a correction, an appeal or another response.
How the work moves.
Denial work starts with understanding what the payer actually needs.
- 01
Collect denial codes and explanation details.
Capture the denial explanation as reported by the source, including applicable codes.
- 02
Separate missing-information issues from other denials.
Identify requested information and separate administrative gaps from issues needing further assessment.
- 03
Prepare a documented follow-up for the billing team.
Send the billing reviewer a concise summary with the evidence and open questions attached.
A request,
with its context intact.
A payer denies a claim for missing information. The response identifies a required document, but it is unclear whether that document was included in the original submission.
Fictional example · No patient data or external action
- Issue
- Required information reported missing
- Check
- Compare the payer response with the submitted record
- Owner
- Billing reviewer determines the appropriate response
Start with the
right information.
Keep these details with the request so the next person can review the work without repeating the intake.
- Denied claim and relevant encounter
- Denial codes and explanation of benefits
- Payer correspondence and reference numbers
- Available supporting records and response deadlines
About this workflow.
Does every denial become an appeal?
No. The right response may be a correction, additional information, an appeal or another action. Qualified staff makes that determination.
Can the workflow guarantee recovery?
No. It organizes the work and supporting information; the payer’s decision and the claim’s circumstances determine the outcome.
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