🚨 Free Playbook
The Denial Prevention Playbook
Root cause frameworks, payer-specific rules, and the exact workflow that keeps denial rates below 4%.
A denial rate above 8% is not a payer problem — it's a process problem. This playbook walks through the systematic approach to identifying denial root causes, building upstream prevention workflows, and creating an appeals process that recovers what slips through. Used by RCMAXIS for every client onboarding.
What's Inside
- The 6 root causes of claim denials — with frequency by specialty
- Payer-specific prior auth requirements for 8 major commercial payers
- The pre-submission checklist that prevents 80% of front-end denials
- How to write an appeal letter that gets overturned — with templates
- Modifier reference guide: 25, 59, 50, TC/26, 22, 51 — when and how
- The denial tracking spreadsheet template (Excel format included)
- Medical necessity documentation guide by procedure category
- Timely filing windows for 15 major payers — current 2026 data
Who is this for?
Practice administrators, office managers, billing supervisors, and physicians who want data to benchmark their practice's billing performance and identify the highest-impact improvement opportunities.