Medical necessity
How to review a medical-necessity denial before drafting an appeal
A practical, review-first checklist for finding the payer's stated criteria, the supporting record, and the appeal deadline.
Denial library
Know what to inspect before you draft the appeal.
Educational checklists for denial teams. Each guide separates the stated reason, record checks, packet contents, and issues that need qualified review.
8 guides · free to read, no account
Prior authorization
Prior-authorization denial appeal checklist
Organize authorization history, payer rules, and supporting records before a response is drafted.
CO-50 reason code
CO-50 denial: what to inspect before appealing
Use the reason code as a starting point, then verify the remittance details, payer criteria, and clinical record.
Behavioral health
Behavioral-health appeal packet: a review-first workflow
A careful workflow for connecting the denial rationale with treatment records while minimizing unnecessary PHI exposure.
Coding and billing
Coding denial triage: corrected claim or appeal?
A structured way to separate billing corrections from disputes that need supporting documentation and payer review.
Level of care
IOP, PHP and residential level-of-care denials: what to check before appealing
When a payer says a lower level of care is appropriate, organize the cited criteria, the step-down history, and the clinical record before anyone drafts.
Concurrent review
Continued-stay denials: responding while treatment is still under way
When a payer stops authorizing additional days or sessions mid-treatment, organize the last covered date, the review history, and the current record quickly.
Peer-to-peer
Preparing for a peer-to-peer review after a behavioral-health denial
A short, review-first way to prepare the treating clinician for a conversation with the payer's reviewer, and to document what was said.
Inspect before you draft.