The codes a practice actually sees, sorted by where each one is created. Pick a stage to see what originates there, or a code to see what it means, why it happens, and what stops it.
- + ~7% across the long tail of remaining codes
Prior authorization absent
“Precertification, authorization, or notification was required and is missing.”
Why it happens
The service was scheduled and performed before anyone confirmed the payer required an auth — or the auth existed but covered a different CPT, date, or place of service than the one billed.
What stops it
An auth requirement check at scheduling, not at check-in, plus a tracked worklist for every pending request. Retro-auth windows are short, so the clock starts the day of service.
Sometimes recoverable — depends on the record and the window. Roughly 19% of denied claims in a typical practice carry this code.
Which is why a denial rate never improves by hiring more people to appeal. Each stage owns a different set of codes and a different fix.
Front end
2 codes · ~28% of denials
Created before the patient is seen — eligibility, benefits, and authorization.
Coding
3 codes · ~34% of denials
Created in documentation and code selection, after the visit but before submission.
Submission
2 codes · ~23% of denials
Created in the claim itself — data, attachments, and timing.
Payer & contract
1 codes · ~8% of denials
Created by the contract and the payer's own adjudication rules.
What each part means and how to use it.
Sorted by origin, not by owner
A denial is almost never created by the team that receives it. Filter by stage to see which codes are born at the front desk, in coding, in the claim itself, or in the contract.
What the code actually means
Each entry carries the payer's own language in plain terms, the root cause behind it, and whether the dollar is realistically recoverable once the denial lands.
What stops it coming back
Reworking a denial recovers one claim. Fixing the cause stops the next hundred — so every code lists the control that prevents it, not just the appeal that answers it.
Put a number on it
Knowing the codes is half of it. The other half is what they cost.
The revenue leakage calculator estimates what denials, aging A/R, and underpayments take out of your practice each month — with a cause breakdown and a twelve-month projection.
Fourteen stages from patient registration to reporting — managed as one connected system, with AI assisting at every step and specialists making the calls.
Patient Registration
Demographic and insurance capture reviewed for accuracy before the visit.
Pattern detection flags mismatched demographics and duplicate records.
A free revenue audit replaces the illustrative shares with your actual denial mix, A/R aging, and payer behavior.
- · Findings you keep, whether or not we work together
- · No patient information requested
- · A named RCM specialist, not a sales queue
Get your free revenue audit
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