Medical claim denials
DenialOS gives revenue-cycle teams a structured way to review claim denial facts, evidence, deadlines, appeal work, payer interactions, and outcomes.
The platform is designed around observed operational state rather than unsupported recovery promises.
Common Questions
What is a medical claim denial?
A medical claim denial is an insurer decision to refuse payment for a healthcare service after adjudication. Denials are different from rejections — denials occur after processing and require formal appeals, while rejections happen before processing and need resubmission.
What are the most common medical claim denials?
The most common medical claim denials are: non-covered services, missing prior authorization, coding errors (incorrect CPT/ICD-10), timely filing violations, medical necessity failures, duplicate claims, and eligibility/coverage issues.
How do I appeal a medical claim denial?
To appeal a medical claim denial: (1) review the EOB for the denial reason, (2) check the appeal deadline, (3) gather supporting documentation, (4) draft the appeal with clinical evidence, (5) submit via the payer's required channel, and (6) track the appeal status.
What is the difference between denial and rejection?
A denial is a post-adjudication decision that a claim is unpayable — it requires formal appeal. A rejection is a pre-adjudication failure (data errors, missing information) — it requires corrected resubmission.