SOC2 evidence

A claim denial is the health plan paying less than the clinic billed: an item on the claim form refused for administrative or technical reasons. Without control, denials become losses accepted out of fatigue. The tracker follows every real in dispute from start to outcome — the money only leaves the radar when someone DECIDES it is lost.

The denial traceable end to end: claim form issued → denied item (with reason and amount) → appeal → outcome (recovered or lost). Each step is dated and the money in dispute never disappears from view — the panel shows how much is open, under appeal, recovered and lost. Register health plans, issue claim forms, record the denials the health plan returns and appeal what is unfair. The two dates of each denial (service and health plan response) feed the vertical's exposure. TISS is optional and off by default.

Register the health plan once (name and ANS registration) and issue claim forms against it: patient, claim form number, service date and billed amount. The Denials button on each claim form opens the dialog where the dispute takes place.

When the health plan responds, record each denied item separately, with the text reason and the exact amount. Item by item, not the total — it is the reason per item that later lets you see WHICH type of refusal repeats (registration, authorization, procedure code) and attack the cause.

Issue the claim form (service billed to the health plan) → record the denial when the response arrives (item, reason, amount, date) → appeal with arguments → outcome: RECOVERED or LOST. Each step is dated; the four cards at the top add up how much is in each stage.

Appeal opens the appeal with written arguments and moves the denial to UNDER APPEAL. When the health plan responds: Recovered (the money came back) or Lost (end of the dispute) — both ask for confirmation. Marking as lost is a conscious decision, never an oversight.

Open means a denial recorded with no appeal and no outcome — the pile of stalled work. Denial appeals have a contractual deadline with the health plan; letting them age turns recoverable money into loss by lapse. Use the card as a work queue, not as scenery.

"How much did the health plan deny, what have I already recovered and what can I still appeal?" — the cards at the top answer in four numbers: open denials, under appeal, recovered and lost, each with the number of items, plus receivables (claim forms net of denials). Below, the screen registers health plans (with the link to the paying customer, without which the claim form does not become a receivable), issues claim forms, records each denied item with reason and amount, and carries the appeal through to the outcome. Each step is dated — the money in dispute never disappears from view.