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 denial may reflect a statutory exclusion, benefit-plan exclusion, lack of a Medicare benefit category, or failure to meet a coverage policy. These are different legal and operational reasons.

Triage checks

Identify the exact benefit or policy basis.Read group code, CARC, RARC, and notice.Check whether an ABN or other notice was required and valid.

Evidence packet

Benefit plan or Medicare benefit sourceCoverage policyMedical recordValid beneficiary notice when applicable

Resolution sequence

01Correct coding or payer routing when the service was misclassified.
02Post a valid contractual or statutory exclusion correctly.
03Appeal when the service meets the applicable benefit and coverage criteria.
04Assign patient liability only when law, notice, and remittance support it.

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