Recoverable denials.

Reason codes can be hard to interpret, and missed deadlines can prevent a correction or appeal. Owed groups denials by the action their reason codes suggest, while keeping low-confidence cases visible for review.

1. 01

   Owed groups denied lines by claim and reads the claim adjustment reason code (CARC) on each.

2. 02

   It sorts the denial by what usually resolves it: correct and resubmit (for example CARC 16, missing information), verify (duplicates and coordination of benefits), credentialing (the provider isn't eligible with the payer), appeal (medical necessity, authorization, timely filing), or the patient's coverage (ended, or not a covered benefit), which is rarely recoverable, so it ranks low.

3. 03

   It values the claim at what the lines should have paid: your contracted rate, the payer's typical rate, or a conservative share of the charge.

4. 04

   Denials handled by more specific findings (wrong payer, add-on codes) are left to them.

• The group and reason code, in words
• What the claim should have paid and how that was worked out
• How the denial is usually resolved
• An appeal deadline

Rules check your remittances against the rates, settings and history available. Each finding shows its evidence; AI does not decide the result.

Correct and resubmit claims denied for billing or data errors. Appeal coverage and medical-necessity denials with documentation, within the payer's appeal window.

Which denied claims should a practice work first?

The ones most likely to be paid for the least effort: billing and data errors you can correct and resubmit, then appeals with strong documentation, sorted by value and deadline.

What is a CARC code?

A claim adjustment reason code: the standard code on a remittance that explains why a payment differs from the amount billed, including why a claim was denied.

• Wrong-payer denials →
• Add-on code denials →
• All ten findings →