Denial specialists who only resubmit claims work the same denials forever. This course teaches the method Revelrex uses in its own operations: categorize every denial, find where it was created, fix the claim, appeal what deserves an appeal, and change the process so the category shrinks. You work real-world denial case files (synthetic patients, realistic payer behavior) from first notice to resolution, and you build a prevention plan for a simulated practice.
Who this course is for
Billers moving into AR and denial roles, denial specialists who want a structured method, and practice managers who want to reduce denials.
What you will be able to do
- Categorize denials and identify their root causes
- Correct and resubmit claims within payer rules
- Write effective appeals with supporting documentation
- Analyze denial trends and present prevention plans
Course content
1Denial foundations (weeks 1 to 2)
- Rejections versus denials versus underpayments
- CARC and RARC codes and what payers mean by them
- Denial capture from ERAs and EOBs
- Building the denial queue with deadlines
2Analysis (weeks 3 to 4)
- Denial categorization and preventability
- Root-cause analysis: registration, authorization, coding, documentation, payer setup
- Trend analysis by payer, provider, code and reason
- Measuring denial rate and recovery
3Resolution (weeks 5 to 6)
- Correctable denials and corrected claim rules
- Appeal levels, deadlines and payer-specific processes
- Writing appeal letters that cite policy and documentation
- Medical necessity denials and working with providers
4Prevention (weeks 7 to 8)
- Front-end fixes: eligibility, authorization and referral workflows
- Coding and documentation feedback loops
- Payer policy monitoring
- Building and presenting a denial prevention plan
Practical component
Forty denial case files worked from capture to resolution, including six written appeals, plus a prevention plan project for a simulated practice.
Assessment
Graded casework, appeal letters and the prevention plan presentation. Pass mark 75%.
Completion
Complete all case files and the prevention project, attend or watch all sessions. A Revelrex certificate of completion is issued.
Check your email for the next steps.