Work the denials worklist

Outcome

Every newly arrived denial is triaged within your SLA, auto-correctable denials are released to the auto-correction engine, manual denials get an appeal or write-off, and nothing slips past timely-filing without a decision.

Prerequisites

Scope	What it lets you do
billing.denial.read	View list / detail
billing.denial.write	Update status, assign, write off
billing.denial.appeal	File an appeal (see 2.5 — File an appeal)
billing.auto-correction.run	Trigger / review auto-corrections (see 2.3)

A working understanding of CARC/RARC codes — see 8.3 — CARC/RARC quick- reference.

The worklist

/denials opens the worklist. Default filters:

Filter	Default
Status	OPEN + IN_PROGRESS
Age	All
Assigned to	Me + Unassigned

Common columns: claim, member, payer, CARC, RARC, denied amount, age, auto-correction status. Sort by age descending to surface aging denials.

Triage flow

Steps

1. Open /denials. Sort by age descending. Take the top row.

2. Click into the denial detail at /denials/:id. Tabs:

   Tab	What you see
   Overview	Claim, member, payer, CARC + RARC, denied amount, dates.
   Auto-correction	Every attempt the engine has made on this denial — status, handler, timestamps, outcome.
   Original claim	Read-only mirror of the claim that was denied.
   Communication	Notes you and teammates leave; visible in the audit log.
   Documents	Any payer correspondence (EOB scan, denial letter PDF).

3. Read the CARC. The header shows the code with a tooltip; click it for the full RARC quick-reference excerpt. If the platform has an auto-correction handler for this CARC, the Auto-correction tab shows either:

   • A SUCCESS attempt (denial is already resolved; close the worklist row).
   • A FAILED or SKIPPED attempt (manual handling needed).
   • Nothing — the engine hasn't run yet; let it; come back later.

   See 2.3 — Trigger or review auto-corrections for the full handler list and how to override.

4. Decide the action:

   Decision	Action
   Auto-correctable	Wait for the engine, or trigger manually if the engine has skipped a viable case.
   Appealable	Click File appeal — see 2.5 — File an appeal.
   Manual rebill	Click Open in rebill — opens the original claim in edit mode; fix the issue (auth missing, modifier wrong, etc.); rebuild and resubmit.
   Write off	Click Write off, supply a reason. The denial moves to WRITE_OFF and the receivable closes.
   Education / route back	Click Add tag and pick the routing tag (e.g. clinical-error, intake-error); the denial appears on the relevant team's queue.

5. Set the next action / due date in the right rail. The Followup field takes a date and a reason; the worklist surfaces denials past their followup date in red.

Bulk actions

Select multiple denials in the list:

Action	Effect
Trigger auto-correction	Runs the engine on each row that has not yet been attempted.
Mass write-off	Asks for one reason; applies to all selected.
Mass appeal	Generates one appeal per row using the same template (see 2.5).
Reassign	Move all selected to a teammate's queue.

Validation

Check	Expected
Worklist age count drops	After working a row, it disappears from the active filter.
Followup date sticks	The right-rail field persists across page reloads.
Auto-correction tab updates within 30s of trigger	Yes — the engine runs synchronously per attempt.
Audit log carries every status change	Yes — see 6.3 — Audit log lookup.

Troubleshooting

Symptom	Cause	Fix
Auto-correction tab is empty	Engine has not run yet	Click Run handlers on the tab to force; or wait 30s.
File appeal button greyed	Denial is not appealable per the post-remittance rules	Confirm the CARC is on the appeal-eligible list (2.5).
Manual rebill produces an immediate denial again	The change does not address the original CARC	Re-read the CARC; sometimes the underlying issue is in the auth or eligibility, not the claim.
Written-off denial reopens	Payer sent a corrected 835 reversing the denial	Reopen the denial via Reopen; the reversal is logged on the Communication tab.

Next

2.3 — Trigger or review auto-corrections