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

The billed units exceeded a Medicare MUE or another payer's utilization edit, or the unit definition was calculated incorrectly.

Triage checks

Recalculate units independently.Check the current setting-specific MUE file and adjudication indicator.Review duplicate lines and modifiers.

Evidence packet

Administration or procedure recordDose and wastage calculationMUE file and policyInvoice or package detail where relevant

Resolution sequence

01Correct unit or line-format errors.
02Do not split lines solely to bypass the edit.
03For supported services above an edit, use the allowed review route with records.
04Correct charge-master conversion factors.

Open full denial guide Plan deadline