References for people who work claims

Denial code library

Every claim adjustment reason code in plain English — what it means, why it happened, how to work it, and how to stop it recurring.

Revenue cycle glossary

835s, ERAs, days in AR, net collection rate — the vocabulary of healthcare billing, defined the way it is actually used.

Revenue leakage calculator

Estimate what unworked denials and underpayments cost your practice each month. Runs in your browser — no signup.

Live product demo

Click through the real interface with a realistic sample book of business. No account, no sales call.

Precertification / authorization absent

The service required prior authorization and none was obtained before it was rendered.

Claim lacks information for adjudication

Something required to process the claim is missing or malformed — the accompanying remark codes name the specific field.

Charge exceeds fee schedule / maximum allowable

The billed charge was above the contracted allowed amount, and the difference is a contractual write-off — not a balance you may bill the patient.

Timely filing limit exceeded

The claim reached the payer after its filing deadline, so it will not be adjudicated — and in most contracts the balance cannot be billed to the patient.

Not deemed a medical necessity

The payer decided the documentation and coding do not establish that the service was medically necessary under its coverage policy.

Service bundled into another payment

The payer considers this service part of another service already paid, so it carries no separate payment.

Not covered by this payer — send to the correct payer

The claim went to the wrong payer or the wrong contractor entirely and needs to be routed elsewhere.

Expenses incurred after coverage terminated

The patient’s coverage under this plan had ended before the date of service.