Denial Root Cause Worksheet

Activity is not the same as resolution.

Denied claims can create a false sense of progress when teams are working individual accounts but the same root cause keeps producing more denials. This worksheet helps organize the denial pattern, assign ownership, and document the process change needed to prevent recurrence.

• Define the denial issue by payer, provider, location, service line, balance, and affected claim count
• Categorize the likely cause: eligibility, authorization, enrollment, claim configuration, coding, documentation, timely filing, COB, posting, or patient responsibility
• Use targeted questions to confirm or rule out the cause
• Assign resolution tasks with owner, due date, and status
• Document how the team will prevent the same denial from repeating

Best use

Use this as a working tool for a denial meeting, payer-specific denial trend, A/R cleanup project, or weekly revenue cycle exception review.

When denial patterns repeat, the question is not only who is working the claim. The better question is what part of the process is creating the denial.