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

Contractual review

0 of 6 packet controls checked

This adjustment family indicates that payment for the service is considered included in another service or allowance. The underlying rule may be NCCI, global surgery, facility packaging, or another payment policy.

Triage checks

Identify the other service or payment that includes the denied line.Check the edit and payment rule effective for the date and setting.Determine whether a modifier exception is permitted and clinically supported.

Evidence packet

Operative or encounter recordCurrent NCCI edit and policy manualDistinct encounter, site, practitioner, or service evidence

Resolution sequence

01Post contractually when the inclusion is correct.
02Correct an unsupported modifier or code choice.
03When services are truly distinct and the rule permits, submit a supported correction or appeal.
04Do not append modifier 59 only to force payment.

Open full denial guide Plan deadline