Skip to main content
The Denials page (/pm/denials) is the central work queue for tracking and resolving claim denials received from payers.

​
Overview

The Denials page displays denial records from the pm_claim_denials table, each linked to a claim, a payer, and optional CARC/RARC codes. The list is sorted by payer appeal deadline (ascending, nulls last) and then by denial date (descending), so the most urgent items surface first. Two tabs organize the workspace: Queue shows the filterable, actionable denial list; Analytics provides aggregate views via the DenialAnalyticsTab component. Users with pm.denials.manage permission can add denials manually, select multiple rows for bulk assignment, and bulk-update selected denials to resubmitted status. Each denial card shows the status badge, denial category, CARC code (if present), the linked claim number and payer name, denial date, denied amount, and the payer appeal deadline. Deadline dates are highlighted in a destructive color when past due, and in a warning color when within 7 days.

​
Who it’s for

Requires permission: PM_PERMISSIONS.DENIALS_VIEW (pm.denials.view). Bulk actions (assign, resubmit, add denial) additionally require pm.denials.manage.

​
Before you start

  • Ensure you have the pm.denials.view permission.
  • Denials appear automatically when ERA processing records them, or they can be added manually via the Add Denial button (requires pm.denials.manage).

​
Steps

1

Open the Denials queue

Navigate to /pm/denials. The Queue tab is active by default, showing all denial records sorted by appeal deadline.
2

Filter by status or category

Use the All Statuses dropdown to filter by a single status (New, In Review, Appealed, Resubmitted, Resolved, Written Off). Use the All Categories dropdown to filter by denial category (Medical Necessity, Coding, Authorization, Eligibility, Timely Filing, Duplicate, Other). Click Clear to remove active filters.
3

Select denials for bulk action

Users with pm.denials.manage see a checkbox on each card and a Select all control. Select one or more denials to reveal the Assign and Resubmit toolbar buttons.
4

Bulk assign denials

Click Assign (n) to open the BulkAssignDenialsDialog and assign the selected denials to a staff member.
5

Bulk resubmit denials

Click Resubmit (n) to update all selected denials to resubmitted status in a single operation.
6

View denial detail

Click anywhere on a denial card (outside the checkbox) to navigate to /pm/denials/:denialId for the full detail view.
7

Add a denial manually

Click Add Denial (requires pm.denials.manage) to open the CreateDenialDialog and enter denial details.
8

View analytics

Switch to the Analytics tab to see aggregate denial data rendered by DenialAnalyticsTab.

​
Key concepts

Denial statuses: values are new, in_review, appealed, resubmitted, resolved, and written_off. Deadline color-coding is suppressed for resolved and written_off denials. Denial categories: medical_necessity, coding, authorization, eligibility, timely_filing, duplicate, other. CARC / RARC codes: and codes are stored on the denial record and displayed as monospace badges on each card.
  • No filters active: “Denials from ERA processing will appear here, or add one manually.”
  • Filters active: “Try adjusting your filters.”
A load error renders a destructive-styled card with a sanitized message and a Retry button that re-runs the query.

​
Creating an appeal

The New Appeal page at /pm/appeals/new launches a full-page six-step wizard for building and submitting a denial appeal package. Requires pm.appeals.submit (PM_PERMISSIONS.APPEALS_SUBMIT). An optional ?denialId= query parameter pre-fills the wizard from an existing denial record. The wizard uses DenialAppealWizard inside a WizardShell timeline layout. Step navigation activates once at least one step has been completed. On successful submission the user is redirected to /pm/denials; the exit action navigates back in browser history. Before you start: your role must include pm.appeals.submit. A denial record in pm_denials should exist before opening the wizard; navigate from the Denials list or detail page to pre-populate ?denialId=. The payer associated with the denial should be configured in pm_payers.
1

Step 1 — Denial Intake

Enter or confirm the denial ID, claim ID, payer, denial receipt date, and denial category. If ?denialId= was supplied, the denial ID field is pre-filled.
2

Step 2 — Deadline & Strategy

Review the calculated appeal deadline (driven by payerAppealDeadlineDays and the receipt date) and select the appeal strategy.
3

Step 3 — Evidence

Attach or describe supporting evidence for the appeal. Changes are persisted in wizard state via onChange as you work.
4

Step 4 — Appeal Letter

Draft or review the appeal letter. The letter step receives denialCategory and payerId from the Intake step to support template selection.
5

Step 5 — Submission Path

Select the submission method (e.g., portal, fax, mail) and provide any required submission details.
6

Step 6 — Review & Submit

Review the full appeal package summary. The deadline is shown alongside all entered data. Click Submit to finalize; the wizard shows a submitting state while the mutation runs. On success the user is redirected to /pm/denials.
Appeal deadline — Computed from payerAppealDeadlineDays plus the denial receipt date entered in step 1. Displayed in steps 2 and 6. ?denialId query parameter — When present, pre-populates the Intake step with the referenced denial’s ID so the wizard can be launched directly from the Denials list or detail page. Timeline layout — The WizardShell renders step progress as a vertical timeline on the side; step titles and icons are shown for all six steps simultaneously, with the current step highlighted. Exit behavior — Clicking the exit control calls onExit, which navigates back one step in browser history (navigate(-1)). Unsaved wizard data is lost on exit.

​
Detail view

The Denial screen displays a single claim denial record and provides status management and appeal creation at route /pm/denials/:denialId.

​
Overview

The page loads a denial via useClaimDenialDetail. The Denial Details card shows denial date, category (from DENIAL_CATEGORY_LABELS), denied amount, CARC code with description (from joined pm_carc_codes), RARC code with description (from joined pm_rarc_codes), and denial reason. The appeal deadline field highlights in warning color if within 7 days and in destructive color if past due. Status-action buttons (In Review, Resubmitted, Resolved, Write Off) are gated by pm.denials.manage. The Appeals card lists linked appeal submissions with status badges (from APPEAL_STATUS_LABELS), appeal level, and created/submitted dates. Users with pm.appeals.submit can launch the Appeal Wizard (navigates to /pm/appeals/new?denialId=...) or open a Quick Draft via CreateAppealSheet.

​
Who it’s for

Requires permission PM_PERMISSIONS.DENIALS_VIEW (enforced via RequirePermission in the route definition). Managing denials requires pm.denials.manage. Submitting appeals requires pm.appeals.submit.

​
Before you start

  • You need pm.denials.view to access this page.
  • Navigate here from the Denials list (/pm/denials).

​
Steps

1

Open a denial record

From the Denials list (/pm/denials), click a row to open the denial detail page.
2

Review denial details

Check the category, denied amount, CARC/RARC codes (with descriptions), denial reason, and appeal deadline.
3

Update status (pm.denials.manage)

Use the status buttons to move the denial to In Review, Resubmitted, Resolved, or Written Off as appropriate.
4

Create an appeal (pm.appeals.submit)

Click Appeal Wizard to navigate to the structured wizard, or Quick Draft to open the inline sheet.
5

Submit a draft appeal (pm.appeals.submit)

In the Appeals section, click Submit on any draft appeal to submit it.

​
Key concepts

Practice Management

Overview of the Practice Management core.

Governance & parity

Documentation coverage and governance.
This page documents shipped product behavior. It is not medical, legal, or billing advice. Verify against your organization’s policies and applicable regulations before using it for clinical, compliance, or billing decisions. Protected health information (PHI) shown in the product is governed by your tenant’s access controls and is never exposed in this documentation.
  • src/routes/pm.tsx
  • src/cores/pm/pages/DenialsListPage.tsx
  • src/cores/pm/hooks/useClaimDenialList.ts
  • src/cores/pm/hooks/useClaimDenialMutation.ts
  • src/cores/pm/types/denials.ts
  • src/cores/pm/pages/DenialAppealWizardPage.tsx
  • src/cores/pm/components/wizards/denial-appeal/DenialAppealWizard.tsx
  • src/platform/permissions/constants.ts
  • src/cores/pm/pages/DenialDetailPage.tsx
  • src/cores/pm/hooks/useClaimDenialDetail.ts
  • src/cores/pm/hooks/useAppealSubmissionList.ts
  • src/cores/pm/hooks/useAppealSubmissionMutation.ts