DenialIntel

The modelled appeal window passed 16 days ago

The 835 reports CARC 27 on 6 Sep 2025, withholding $25.52 from the provider. The matched 834 shows coverage 25 Apr 2024 to open, which includes the service date of 18 Jun 2025. Modelled recoverable $25.52, less an estimated rework cost of $31.00, leaves -$5.48 net. The configured appeal window for this payer ends 6 Sep 2026, 16 days ago. Recommended action: Expenses incurred after coverage terminated. Check the enrolment span: if the member was covered on the service date this is wrongly denied and worth appealing. Confirm the contractual deadline and any exception, reconsideration or correction route with the payer before closing the case. On these estimates the work costs more than it returns; that is a judgement about this model's figures, not a rule.

From: Denial derivation: root cause, appealability, the recoverable amount net of an estimated rework cost, and a filing deadline derived from the denial date.

Limits: The deadline and the recoverable amount are application estimates. The deadline is the denial date plus a configured per-payer window, not a term read from the payer's contract or an appeal notice, and the recoverable figure is a model rather than a promise of payment. Confirm both against the policy before relying on them.

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