DENIALS & APPEALS

Discussion List

• Payors requesting Code removal

  31 views 2 comments 0 points Most recent by Tonya.Demyon December 2025
• Making the case for a physician advisor program in behavioral health

  9 views 1 comment 0 points Most recent by RHirsch November 2025
• Bed Charging Policy

  91 views 1 comment 0 points Most recent by ecutter May 2025
• Responsibility for Denials Analysis

  70 views 0 comments 0 points Started by hildebjl February 2025
• MUE for CPT Code 11045

  231 views 1 comment 0 points Most recent by slgincconsulting@aol.com January 2025
• Optume Pre-Payment Denials Tips

  215 views 2 comments 0 points Most recent by Lashunda.Murray@UTSouthwestern.edu January 2025
• NDC box vs vial

  308 views 1 comment 0 points Most recent by luczekle@sjchs.org October 2024
• N345 Date range not valid with units submitted

  376 views 2 comments 0 points Most recent by kay.larsen@ah.org May 2024
• Appeal Letter Templates

  1.1K views 7 comments 0 points Most recent by slgincconsulting@aol.com January 2023
• Utilization Mgmt under Revenue Integrity

  265 views 1 comment 0 points Most recent by mrborden January 2023
• Decision matrix for audit appeals

  293 views 1 comment 0 points Most recent by laura.tierney@dchstx.org November 2022
• Org chart

  146 views 0 comments 0 points Started by kshumpert March 2022
• unwarranted denials IP or OP? from Specific payers UHC or Humana

  863 views 5 comments 0 points Most recent by RHirsch January 2022
• RAC Baseline Additional Documentation Request (ADR) Limits

  122 views 0 comments 0 points Started by Andrew.Reiten January 2022
• IP LOC and DRG/Coding Clinical Validation on the same encounter

  131 views 0 comments 0 points Started by christy.basden@iredellhealth.org January 2022
• Humana denials on chemo waste based on vial size

  507 views 2 comments 0 points Most recent by HeatherDubois November 2021
• OR Base Rate Charge

  657 views 5 comments 0 points Most recent by catherine-fiala@uiowa.edu October 2021
• Medicare and Medicare MA Inpatient denials - Change the patient status from IP to OP or leave?

  271 views 1 comment 0 points Most recent by RHirsch September 2021
• Denial prevention committees

  633 views 4 comments 0 points Most recent by virginialbryan@gmail.com April 2021
• Templates perhaps for appeal rationale for Sepsis (Sepsis-3) and Severe Malnutrition denials.

  249 views 1 comment 0 points Most recent by virginialbryan@gmail.com April 2021
• Appeal metrics

  549 views 3 comments 0 points Most recent by ptwiss December 2020
• room and board what's included how to stop denials

  789 views 4 comments 0 points Most recent by dsoult September 2020
• Cigna Denials per their Reimbursement Policy

  1.2K views 2 comments 0 points Most recent by mglynn431 April 2020
• UHC denails

  181 views 0 comments 0 points Started by mglynn431 April 2020
• Readmission within 30 days denial

  523 views 1 comment 0 points Most recent by ronaldhirsch November 2019
• readmisson

  227 views 1 comment 0 points Most recent by RHirsch April 2019
• Winning DRG appeal but getting denied for Clinical Validation

  395 views 1 comment 0 points Most recent by RHirsch June 2018
• Physician Advisor Services

  188 views 0 comments 0 points Started by btadwalt March 2018