Denials worklist

Outcome

Every denial is triaged within your SLA, auto-correctable denials are released to (or confirmed with) the engine, manual denials get an appeal, write-off, or rebill decision, 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
billing.auto-correction.run	Trigger / review auto-corrections

A working understanding of CARC / RARC — see 9.3 — CARC / RARC reference.

The worklist

/denials opens with default filters:

Filter	Default
Status	OPEN + IN_PROGRESS
Age	All
Assigned to	Me + Unassigned
Auto-correction status	All

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

The triage flow

Steps

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

2. Click into the 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 — status, handler, timestamps.
   Original claim	Read-only mirror of the claim that was denied.
   Communication	Notes you and teammates leave.
   Documents	Any payer correspondence (EOB scan, denial letter PDF).

3. Read the CARC. Hover for tooltip; click for the full reference excerpt. The platform's auto-correction tab will already show what the engine has tried (or not).

4. Decide the action:

   Decision	Action
   Auto-correctable	Wait for the engine, or trigger manually if skipped a viable case. See 5.3.
   Appealable	Click File appeal — see 5.5.
   Manual rebill	Open in rebill — see 5.4.
   Write off	Write off with reason — see 5.6.
   Educate / route back	Add tag and pick the routing tag (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

Action	Effect
Trigger auto-correction	Runs the engine on each row not yet attempted.
Mass write-off	One reason; applies to all selected — chapter 5.6.
Mass appeal	One template; applies to all selected — chapter 5.5.
Reassign	Move to a teammate's queue.
Tag for education	One tag; applies to all selected.

Bulk operations write per-row audit entries — your name lives on each.

The denial state machine

See 9.2 — Status reference for the full diagram.

Validation

Check	Expected
Worklist age count drops as you work rows	Yes; refresh confirms.
Followup date sticks	Yes across reloads.
Auto-correction tab updates within 30s of trigger	Yes.
Audit log captures every status change	Yes.

Troubleshooting

Symptom	Cause	Fix
Auto-correction tab is empty	Engine has not run yet	Click Run handlers; or wait 30s.
File appeal button greyed	Denial isn't appealable per post-remittance rules	Confirm the CARC is on the appeal-eligible list (5.5).
Manual rebill produces an immediate denial again	Change didn't address root cause	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 via Reopen; the reversal is logged on Communication.

Where to next

• 5.2 — Read a CARC / RARC — what the codes mean.
• 5.3 — Auto-correction console — the engine in detail.