Denials & Appeals
Every article we've published on Denials & Appeals.
Claim Rejection vs. Denial: The Difference That Decides How Fast You Get Paid
Rejections and denials look similar but are handled completely differently — and confusing them wastes days and appeals you didn’t need. Here is how to tell them apart and route each one correctly.
The Medicare Appeals Process: All 5 Levels and Their 2026 Deadlines
A denied Medicare claim is not the end — it is the start of a five-level appeal process. Miss a deadline and you forfeit the money. Here is each level, the filing window, and the 2026 dollar thresholds.
Medical Necessity Denials and the ABN: The GA, GZ, GX and GY Modifiers Explained
When Medicare is likely to deny for medical necessity, the Advance Beneficiary Notice decides who pays. Get the ABN and its modifiers right and you protect revenue; get them wrong and you eat the cost. Here is the definitive guide.
Coordination of Benefits Denials: How to Fix and Prevent the CO-22 Trap
COB denials — led by code CO-22 — can be 10–20% of all rejections, and they stall cash on claims you have already earned. Here is why they happen, how to resolve them fast, and how to stop them at registration.
CO, PR, OA, PI: What the Claim Adjustment Group Codes Actually Mean
Every line on a remittance carries a group code that says who owes the money — the payer, the patient, or nobody. Misread it and you write off what you could bill, or bill patients for what you owe. Here is the plain-English guide.
