Denial Management
Sorted by recovery value. Take action before appeal deadlines close.
Total at risk
$28,940
Recoverable
$10,740
Avg days to deadline
25d
Gerald Mitchell
Aetna
Aetna says the service wasn't medically necessary based on their clinical review. A letter of medical necessity with supporting documentation can overturn this.
Frank Torres
UnitedHealthcare
UnitedHealthcare considers the second procedure already included in the payment for the first. Add modifier 59 to the second line to show they were separate procedures.
Susan Barnes
UnitedHealthcare
Claim was filed after the timely filing deadline. Originally denied, but patient had good cause documentation. Appeal was approved.
Dorothy Chang
Blue Cross Blue Shield FL
This looks like an exact duplicate of a claim already paid. Review if this was resubmitted by mistake — if not, send proof of original submission dates.
Patricia Lee
Medicare Part B
Medicare says two of the items billed are considered one service — you can only bill one of them separately. Attach the podiatrist certification and resubmit.
William Park
Medicare Part B
Prior authorization was required before the service was performed, but no auth was on file. Second-level appeal denied — appeal window closed.
Helen Garcia
Blue Cross Blue Shield FL
This procedure isn't covered under this patient's insurance plan. Call Blue Cross to verify plan benefits, then bill the patient directly for their portion.