Our denial workflow
- Categorize every denial by reason code (CARC/RARC), payer, provider and CPT code
- Correct and resubmit claims with fixable errors (modifiers, demographics, place of service)
- Write and track appeals with supporting documentation when the payer is wrong
- Escalate patterns to payer representatives
- Feed root causes back to the front desk and clinicians as simple checklists
Common denials we see in behavioral health
Authorization missing or exhausted (CO-197 and similar), eligibility or coverage terminated (CO-27), medical necessity (CO-50), bundling and add-on code issues (CO-97), modifier and place-of-service mismatches on telehealth claims (CO-4), and timely filing limits (CO-29). Each one has a different fix, and most are preventable.