Skip to main content
Denied claims are not lost revenue until you stop working them. Practices that work denials weekly recover most of them; practices that work them “when we get to it” donate 3-5% of revenue to payers.

​
Triage by CARC code

Every denial arrives with a CARC/RARC code in the 835. Sort into three buckets:

​
Run the weekly ritual

One owner or biller hour, same day every week: pull the denial report, clear the fix-and-resubmit queue, file appeals over your dollar threshold (a $40 denial may not be worth 30 minutes, a pattern of them is), and check timely filing and appeal deadlines. Both clocks are short and unforgiving.

​
Kill root causes

Track denials by root cause, not just by payer. Three upstream fixes eliminate most volume: verify eligibility before every visit, get prior auth before the procedure not after, and fix the top recurring coding edit in your specialty. Denial rate by payer belongs on your KPI sheet; above ~5-8% means an upstream process is broken, and it is also evidence for dropping a payer at renewal.