Denial Management

The process of categorizing, working and preventing insurance claim denials to recover revenue.

Good denial management treats every denial as two jobs: work this one (correct or appeal it), and prevent the next one (fix the root cause). Around two-thirds of denials are never reworked, so speed and prioritization matter.

Tracking denials by reason code (CARC/RARC) reveals which upstream step to fix.

Denial Management