Denial Guides
Structured AR resolution workflows by denial category — what the denial means, what to verify, recommended next actions, documentation, escalation and QA checkpoints.
All denial guides are AR Guide editorial content: general practice guidance, never payer-specific policy. Always confirm specifics with the payer.
Timely Filing
AR Guide KnowledgeThe payer denied the claim because it was submitted after the filing deadline. Success depends on proving timely submission or finding a valid extension.
Eligibility & Coverage
AR Guide KnowledgeCoverage could not be verified or was not active for the date of service — member not found, coverage lapsed, or eligibility requirements not met.
Authorization
AR Guide KnowledgeThe service required prior authorization, precertification, or pre-treatment review that was missing, expired, or did not cover what was billed.
Referral
AR Guide KnowledgeThe service required a referral from a primary care or network provider that was missing, expired, or did not cover the billed service.
Missing Information
AR Guide KnowledgeThe claim was missing required information or had a submission or billing error, so the payer could not process it. This is usually a correction, not an appeal.
Duplicate Claims
AR Guide KnowledgeThe payer identified the claim as a duplicate of a previously processed claim. Verify the original before doing anything — this is often a no-action item.
Non-Covered Services
AR Guide KnowledgeThe service is not covered under the patient's benefit plan — an exclusion, a coverage limit, or a service the plan simply does not include.
Medical Necessity
AR Guide KnowledgeThe payer determined the service was not medically necessary or reasonable according to its policy. These denials are documentation-driven.
Coding & Modifiers
AR Guide KnowledgeThe payer identified a coding issue — a mismatched or missing modifier, an inconsistent diagnosis, a revenue-code mismatch, or an unbundled service.
Documentation Required
AR Guide KnowledgeThe payer requested medical records, orders, notes, certificates, or other documentation before it will process the claim.
Coordination of Benefits
AR Guide KnowledgeAnother plan may be primary, the primary's payment was not applied correctly, or the claim belongs with a different payer under COB rules.
Patient Responsibility
AR Guide KnowledgeThe amount is the patient's responsibility under the plan — deductible, coinsurance, copayment, or a non-covered amount the patient may be billed.
Provider & Credentialing
AR Guide KnowledgeThe provider type, enrollment, credentialing, network status, or facility certification does not support payment for the service billed.
Incorrect Payer
AR Guide KnowledgeThe claim was submitted to the wrong payer or plan type and must be sent to the payer that actually covers the service.
Bundling & Included Services
AR Guide KnowledgeThe payment for this service is included in the payment for another service — a global period, an NCCI edit, or a plan rule that bundles the service.