Not all denials are equal. A 5% denial rate on high-dollar surgical claims outranks a 20% denial rate on $25 vaccine codes every time. Enter your denied dollars by category — get a dollar-weighted action plan that tells you exactly what to fix first, what to fix next, and why.
How to use this tool: Pull your denial summary report from your clearinghouse or practice management system. For each denial category, enter the total denied dollars for the month and the number of denied claims (optional but improves the analysis). Select whether the denials are concentrated at one payer or spread across multiple — this changes the root cause and the fix.
Where to find this data: In most clearinghouse portals (Availity, Change Healthcare, Office Ally, etc.), look for a "Denial Summary by Reason Code" or "Denial Analysis" report. Group the reason codes into the categories below. Your practice management system may also have a denial dashboard — look for a report that shows denied dollar amounts by denial reason category for the current month.
All claims sent to payers this month
Total claims returned as denied
Sum of all denied charges this month
Running Total
Claims categorized: 0
Dollars categorized: $0
✓ Totals match
Denied Dollars by Category — Enter what you know, skip what you don't
Eligibility / Coverage
Patient not covered, inactive insurance, wrong plan billed, coverage terminated
Prior Authorization
Missing authorization, expired auth, wrong service authorized, auth not obtained