Categorize common denial scenarios by the workstream that should own the fix.
Sort each denial by the first workstream that should investigate the root cause. Eligibility or COB Coding or modifier Medical necessity Authorization or referral Patient liability or notice Coverage inactive because old plan ID was submitted after patient changed jobs. NCCI edit fired because distinct-site modifier is missing from a supported procedure pair. Lab denied because submitted diagnosis is not on the coverage article's covered indication list. MRI denied because authorization number belongs to a different rendering location. Medicare service denied as likely noncovered and no valid pre-service ABN is on file. Claim has the right CPT but diagnosis pointer…
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