---
id: billing-denial-management
title: Manage claim denials and appeals
module: billing
audience: [billing]
roles: [biller, admin]
type: how-to
estimated_minutes: 8
last_reviewed: 2026-07-01
app_route: /facility/{facility_uuid}/billing
related:
- billing-overview
- billing-work-queue
- billing-ar-aging
- billing-era-posting
tags: [billing, denials, appeals, AR]
---
# Manage claim denials and appeals
Triage a denied claim, work and track an appeal, and close the denial record when the payer renders a final decision.
## Before you start
- A claim has been submitted and returned with a denial.
- You have the denial reason code and remittance advice from the payer or ERA.
- You have the `biller` role, or `admin`.
## Denial appeal status reference
Every denial record carries an **appeal status**. These are the values Medipyxis tracks, roughly in order from initial triage through final resolution:
| Appeal Status | Meaning |
|---|---|
| **Not Started** | Denial received; no action taken yet. |
| **Not Appealed** | A decision was made not to appeal this denial. |
| **Needs Review** | A biller needs to review the denial and decide the response. |
| **In Research** | The denial reason is being researched. |
| **Pending Documentation** | Waiting on records/documentation to support the appeal. |
| **Pending Provider Input** | Waiting on the provider for clinical input. |
| **Ready to Appeal** | The appeal is prepared and ready to send. |
| **Appeal Submitted** | The appeal has been sent to the payer. |
| **Under Payer Review** | The payer is reviewing the appeal. |
| **Additional Info Requested** | The payer requested more information. |
| **Appeal Accepted** | The payer accepted the appeal for reconsideration. |
| **Appeal Approved** | The appeal was approved — the claim should proceed to payment. |
| **Appeal Denied** | The appeal was denied by the payer. |
| **Claim Corrected & Resubmitted** | The claim was corrected and resubmitted rather than formally appealed. |
| **Closed — No Further Action** | Denial closed; nothing further to do. |
| **Closed — Written Off** | Denial closed and the balance written off. |
## Steps — triage a denial
1. **Open the Denials view.** From the Billing module, open **Denials**.
*The Denials view. The **Appeal Status** column shows the current stage for each denial. Items in **Not Started** or **Needs Review** need attention first.*
2. **Identify priority denials.** Sort by aging to surface the oldest denials first, and filter by **Appeal Status** to find items that have not been actioned.
3. **Open the denial record.** Click a denied claim to open the denial detail. Review:
- The denial reason code and description from the ERA or payer correspondence.
- The original claim's date of service, procedure codes, and diagnosis codes.
- Any previous appeal history in the activity log.
4. **Set status to Needs Review.** This signals to other billers that the denial is being worked.
5. **Determine the root cause.** Common denial categories and typical responses:
| Denial Category | Typical Response |
|---|---|
| Missing or invalid documentation | Request records; set **Pending Documentation** |
| Medical necessity | Gather clinical support; set **Pending Provider Input**, then **Ready to Appeal** |
| Duplicate claim | Verify and void the duplicate; **Claim Corrected & Resubmitted** or close |
| Timely filing | Gather proof of timely filing (clearinghouse timestamps); set **Ready to Appeal** |
| Coding error | Correct the codes and resubmit; **Claim Corrected & Resubmitted** |
| Authorization missing | Obtain retroactive auth if available; otherwise **Not Appealed** with a note |
## Steps — work and submit an appeal
6. **Gather supporting documentation.** Attach the payer's denial EOB/ERA detail, clinical notes supporting medical necessity, and any payer-specific appeal form. Set the status to **Pending Documentation** while you collect these.
7. **Prepare the appeal.** Write the appeal narrative in the notes: reference the claim number, date of service, denial reason code, and the clinical or regulatory basis for the appeal. When ready, set the status to **Ready to Appeal**.
8. **Submit the appeal to the payer.** Send the appeal package through the payer's channel (portal, fax, or mail) and record the confirmation number in the notes.
9. **Set status to Appeal Submitted** and record the submission date. Move it to **Under Payer Review** while you wait, and to **Additional Info Requested** if the payer asks for more.
Medicare first-level redeterminations must be filed within 120 days of the initial denial; second-level reconsiderations within 180 days. Track these deadlines in the notes — Medipyxis does not currently auto-calculate appeal deadlines.
## Steps — track to resolution
10. **Record the payer's decision.**
- Approved → set **Appeal Approved**. The claim should reprocess for payment and post through an ERA.
- Accepted for review → **Appeal Accepted**.
- Denied → **Appeal Denied**; decide whether a further level of appeal or a correction is warranted.
- Corrected instead of appealed → **Claim Corrected & Resubmitted**.
11. **Close the denial.** When no further action is warranted:
- Resolved, nothing more to do → **Closed — No Further Action**.
- Balance written off → **Closed — Written Off**.
## Result
The denial record reflects the current appeal status and a full activity trail. Closed denials drop out of the active Denials view; use the status filter to include them in reporting.
Do not set a denial to **Closed — Written Off** without supervisor approval. Write-offs affect your facility's net collection rate and are reviewed in reporting.
Review the **Claims Reports** in the [Reports Center](./ar-aging.md) periodically to spot systemic issues — for example, a payer consistently denying a specific modifier — that can be corrected upstream at the coding level.
## Troubleshooting
| Symptom | Likely cause | What to do |
|---|---|---|
| Denial not visible in the Denials view | ERA has not been posted yet | Check the ERA/Payments view; post the ERA first |
| **Appeal Status** dropdown is read-only | Your role does not have edit access | Ask your administrator to verify your role permissions |
| Denial shows **Appeal Approved** but no ERA payment received | Payer reprocessing is pending | Wait for the next ERA cycle; check the Stedi dashboard for a pending 835 |
## Related
Auto-rendered from `related:` in frontmatter.