M/S.PURUHOOTHIKA SOFTCONDUCTOR SERVICES HEVS INDUSTRIES.
(PURUHOOTHIKA TECHNOLOGIES LIMITED).
HOSPITAL INFORMATION MANAGEMENT SOFTWARE(HIMS) DESIGNED AND DEVELOPED.
THIS HIMS ALL RIGHTS ARE RESERVED BY PURUHOOTHIKA.
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BILLING AND INSURANCE
DENIAL & REJECTION MANAGEMENT
Denial & Rejection Management
Total Denials (MTD)
142
Technical Rejections
68
At-Risk Revenue
$284,500
Recovery Rate
64.5%
Active Claim Denials & Rejections Queue
Claim ID
Patient Name
Payer
Type
Reason / Code
Amount
Status
Action
CLM-89421
Sarah Jenkins
BlueCross
Denial
CO-50: Medical Necessity (Inpatient)
$12,450
Pending Appeal
CLM-89455
Robert Vance
Aetna
Rejection
PR-16: Missing / Invalid CPT Modifier
$3,100
Clearinghouse Fix
CLM-89502
Emily Davis
Medicare
Denial
CO-197: Pre-authorization absent
$8,200
Docs Submitted
CLM-89510
Michael Chang
UnitedHealthcare
Rejection
Missing Subscriber ID / DOB mismatch
$1,550
Front-Desk Check
Denial Management Protocol (Best Practices)
- Capture & Categorize: Separate instant clearinghouse rejections (fix and resubmit immediately) from post-adjudication insurance denials.
- Root Cause Analysis: Track top rejection drivers like missing pre-authorizations or invalid CPT/ICD codes using insights from your [Medical Billing & Coding Overview](https://www.medicalbillersandcoders.com/article/denial-management-in-medical-billing.html).
- Prioritize Appeals: Focus staff efforts on high-dollar claims and cases close to timely filing deadlines.
Denial & Rejection Management
Date: Oct 2026
Total Denials (MTD)
142
Technical Rejections
68
At-Risk Revenue
$284,500
Recovery Rate
64.5%
Active Claim Denials & Rejections Queue
| Claim ID | Patient Name | Payer | Type | Reason / Code | Amount | Status | Action |
|---|---|---|---|---|---|---|---|
| CLM-89421 | Sarah Jenkins | BlueCross | Denial | CO-50: Medical Necessity (Inpatient) | $12,450 | Pending Appeal | |
| CLM-89455 | Robert Vance | Aetna | Rejection | PR-16: Missing / Invalid CPT Modifier | $3,100 | Clearinghouse Fix | |
| CLM-89502 | Emily Davis | Medicare | Denial | CO-197: Pre-authorization absent | $8,200 | Docs Submitted | |
| CLM-89510 | Michael Chang | UnitedHealthcare | Rejection | Missing Subscriber ID / DOB mismatch | $1,550 | Front-Desk Check |
Denial Management Protocol (Best Practices)
- Capture & Categorize: Separate instant clearinghouse rejections (fix and resubmit immediately) from post-adjudication insurance denials.
- Root Cause Analysis: Track top rejection drivers like missing pre-authorizations or invalid CPT/ICD codes using insights from your [Medical Billing & Coding Overview](https://www.medicalbillersandcoders.com/article/denial-management-in-medical-billing.html).
- Prioritize Appeals: Focus staff efforts on high-dollar claims and cases close to timely filing deadlines.