> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Work your denials

> A denial workflow that runs weekly: triage by CARC code, fix and resubmit, appeal what's worth appealing, and kill root causes.

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.

```mermaid theme={null}
%%{init: {'themeVariables':{'fontFamily':'inherit','fontSize':'14px'}}}%%
flowchart TD
    A[835 posts with CARC/RARC] --> B{Triage by code}
    B -->|Fixable error| C[Correct and resubmit]
    B -->|Payer error / disagree| D[Appeal with documentation]
    B -->|True write-off| E[Write off with reason code]
    C --> F[Track by root cause]
    D --> F
    F --> G[Fix upstream: eligibility, coding, auth]
```

## Triage by CARC code

Every denial arrives with a [CARC/RARC code](/concepts/carc-rarc-denial-codes)
in the 835. Sort into three buckets:

| Bucket               | Typical CARCs                                                          | Action                                                    |
| -------------------- | ---------------------------------------------------------------------- | --------------------------------------------------------- |
| Fix and resubmit     | 16 (missing info), 97 (bundled), 109 (wrong payer), eligibility errors | Correct within days; these are the majority               |
| Appeal               | 50 (not medically necessary), 197 (no auth), underpayments vs contract | Written appeal with chart notes and the contract language |
| Legitimate write-off | Duplicate, past timely filing, true non-covered service                | Write off with a reason code so the report stays honest   |

## 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](/guides/practice-kpis); above
\~5-8% means an upstream process is broken, and it is also evidence for
dropping a payer at [renewal](/guides/payer-contracting).

## Related

* [The claim lifecycle](/concepts/claim-lifecycle)
* [CARC and RARC: denial codes](/concepts/carc-rarc-denial-codes)
* [Patient responsibility](/guides/patient-responsibility)
* [The numbers that matter](/guides/practice-kpis)
* [Payer contracting and fee schedules](/guides/payer-contracting)