Denial Management and Appeal Agent

Denied claims pile up and many are never appealed before the deadline, which leaves earned revenue unpaid. When denials arrive on remittance files, this agent sorts them by reason code, value and deadline. For each one it reads the claim, notes and records to find the cause: missing authorization, coding issue, eligibility or timely filing. It decides whether to correct and resubmit or to appeal, and drafts the corrected claim or appeal letter with supporting records. Coding denials go to coder review first. The biller approves every submission. It tracks deadlines and later checks whether each claim was paid. If not, it drafts a second appeal or suggests a write-off for the biller to approve. Each month it reports the top denial causes. Edge case: the authorization exists under a different date, so the agent attaches it.