Back-end revenue cycle · Denials

Denial Triage & Appeal Builder

Load a denial worklist. Each line is classified by its adjustment reason code, routed to the team that can fix it, and ranked by expected recovery and days left to appeal. Pick a line to draft the appeal or corrected-claim letter, and see which upstream fixes would have prevented the most dollars.

Worklist, highest priority first

Claim	Denial	Action	Amount	Days left

Use your own worklist (CSV)

Columns: claim_id, payer, payer_type (medicare, ma, medicaid, commercial), cpt, carc, amount, denial_date (YYYY-MM-DD)

Where the dollars are

by root cause

Upstream fixes

Letter builder

Assumptions

Expected recovery = denied amount × a starting overturn rate per reason code. Those rates are placeholders, written to be replaced with a health system's own appeal history.
Lines with 14 or fewer days left get a 1.6× urgency weight and 15 to 30 days get 1.3×. Expired lines drop to zero.
Appeal windows: Medicare FFS uses 120 days plus the 5-day receipt presumption. Medicare Advantage, Medicaid and commercial windows are defaults to replace with contract terms.
Reason-code descriptions are plain-language summaries of X12 CARCs. Remark codes (RARCs) are not parsed yet.