Denial Resolution Tool

Denial Evidence Packet Builder

Turn a denial family into a controlled checklist for triage, evidence collection, resolution routing, and prevention.

Use de-identified facts only. Do not type or print patient names, Medicare identifiers, claim numbers, dates of birth, medical records, or other protected information into this public tool.

Denial family

Likely route

Appeal review

0 of 7 packet controls checked

This denial family indicates that required authorization, precertification, or notification was not obtained or did not match the claim facts.

Triage checks

Confirm whether authorization was actually required for this plan and date.Compare approval number, code, provider, setting, units, and date range.Read the payer's RARC and denial notice for mismatch detail.

Evidence packet

Authorization request and decisionClinical submissionPortal or call referenceProof that claim facts match approval

Resolution sequence

01Correct a claim that omitted a valid matching authorization number.
02Request retroactive review only when payer rules permit and facts support it.
03Appeal a disputed requirement or matching error with the decision trail.
04Fix scheduling and change-control workflow upstream.

Open full denial guide Plan deadline