Denial Review and Assignment of Appeals

Purpose

To ensure that each denial is accurately reviewed and its basis identified—using denial letters, payer portals, PANs (Patient Accounting Notes), remittance advice, and/or Explanation of Benefits (EOBs) so appeals are assigned to the most appropriately skilled appeal writer.

Policy

All payer denials will be systematically reviewed using the denial letter, payer portals, PAN notes, and/or EOBs to determine the specific service, code, and reason for denial. Denials are then categorized and routed to appeal writers with expertise in the relevant denial type to maximize the likelihood of successful appeal.