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19+ Practical Guides

How Do I...

Step-by-step answers to real-world medical billing, denial management, eligibility, appeals, and revenue cycle questions — with quick answers, common mistakes, and related resources.

Featured Questions

Denial ManagementBeginner

How do I work a CO-16 denial?

Pull the ERA/EOB and read the accompanying RARC code(s) — they tell you exactly what information is missing. Correct the specific deficiency, submit a corrected claim using frequency code 7, and monitor for payment within 30 days.

Revenue CycleBeginner

How do I read an EOB?

An Explanation of Benefits (EOB) is the patient-facing version of the remittance advice. Start with the patient and claim information section, then review the service line adjustments, identify the payment amount, and check for any CARC/RARC codes that explain reductions or denials.

Denial ManagementBeginner

How do I correct a denied claim?

First determine whether the claim needs a correction or a formal appeal — if information was missing or wrong, submit a corrected claim (frequency code 7). If you disagree with the denial, file an appeal. Fix the specific issue, resubmit, and track the claim to resolution.

AppealsIntermediate

How do I submit an appeal to UHC?

UHC allows 180 days from the remittance date to file a standard appeal. Gather the denial letter, supporting clinical documentation, and a cover letter, then submit via the UHC Provider Portal, fax, or mail. UHC has 30 days to respond to standard appeals.

AppealsIntermediate

How do I submit a payer reconsideration?

Use reconsideration when you want the payer to review a processed claim again without jumping straight to a formal appeal. Confirm the payer offers reconsideration, identify the exact processing issue, submit a concise request with supporting documents through the payer portal or approved channel, save the confirmation number, and follow up within the payer's stated timeframe.

Denial ManagementBeginner

How do I work a denial without calling the payer?

Start with the ERA/EOB, claim status, eligibility, payer policy, and portal tools. Many denials can be resolved through corrected claims, portal reconsiderations, secure messages, or appeals without a phone call. Call only when the information or action you need is unavailable electronically.

Denial ManagementIntermediate

How do I choose between a corrected claim, reconsideration, appeal, or coding review?

Use a corrected claim when the submitted claim data is wrong, reconsideration when the payer should re-review a processed claim, a formal appeal when you disagree with the payer's coverage or medical necessity decision, and coding review when the resolution depends on CPT, HCPCS, ICD-10, modifier, bundling, or code-pair analysis.

Denial ManagementBeginner

How do I know when to adjust a denied claim?

Do not adjust a balance just because a claim denied. First prove what happened on the final ERA/EOB, reconcile the dollars, and determine whether payment can still be recovered. Adjust only when the payer adjudication or contract supports a provider write-off, no valid recovery path remains, and your organization authorizes the adjustment.

Revenue CycleBeginner

How do I write a strong insurance collections account note?

Use a four-part structure: what happened, what you reviewed or did, why that action was correct, and what happens next. Include the denial reason, key dollar amounts, research performed, action taken, remaining balance, and follow-up timeframe so the next representative can understand the account without repeating your work.

How do I know when to send a denial to Coding?

Send a denial to Coding when resolving it requires someone to choose, change, validate, or defend CPT/HCPCS, ICD-10, modifiers, code pairs, NCCI edits, bundling rules, or documentation-to-code decisions. Do not send administrative denials like COB, eligibility, timely filing, or missing authorization to Coding unless there is a separate coding question.

AppealsBeginner

How do I know when to appeal a denial?

Appeal when the claim is correct as billed, you disagree with the payer decision, and you have evidence that supports payment. Do not appeal a claim that simply needs a billing correction, COB update, eligibility fix, coding correction, or missing information.

AppealsBeginner

How do I submit a reconsideration or appeal by payer?

The submission method depends on the payer and product. UHC and Regence now rely heavily on electronic portal submission, Humana and Aetna support Availity workflows, Premera currently uses provider appeal forms with fax/mail while its Availity rollout is delayed, Medicare uses the responsible MAC, and TRICARE claim appeals have region-specific fax/mail routes.

Denial ManagementBeginner

How do I work my first denial step by step?

Start with the balance and final ERA/EOB, identify the CARC/RARC, review claim history and payer status, decide who owns the problem, choose the correct resolution path, complete the action, then write a note that shows the money, research, action, and follow-up.

Most Popular Questions

How do I work a CO-16 denial?

Denial Management · Beginner

How do I read an EOB?

Revenue Cycle · Beginner

How do I correct a denied claim?

Denial Management · Beginner

How do I submit an appeal to UHC?

Appeals · Intermediate

How do I know if a service needs prior authorization?

Prior Authorization · Beginner

How do I verify Aetna benefits?

Eligibility · Beginner

How do I work a CO-50 denial?

Denial Management · Intermediate

How do I know when to adjust a denied claim?

Denial Management · Beginner

How do I use modifier 25?

Coding · Intermediate

How do I write a strong insurance collections account note?

Revenue Cycle · Beginner

How do I know when to send a denial to Coding?

Coding · Beginner

How do I know when to appeal a denial?

Appeals · Beginner

How do I submit a reconsideration or appeal by payer?

Appeals · Beginner

How do I work my first denial step by step?

Denial Management · Beginner

Recently Added

Denial ManagementBeginner

How do I know when to adjust a denied claim?

Do not adjust a balance just because a claim denied. First prove what happened on the final ERA/EOB, reconcile the dollars, and determine whether payment can still be recovered. Adjust only when the payer adjudication or contract supports a provider write-off, no valid recovery path remains, and your organization authorizes the adjustment.

Revenue CycleBeginner

How do I write a strong insurance collections account note?

Use a four-part structure: what happened, what you reviewed or did, why that action was correct, and what happens next. Include the denial reason, key dollar amounts, research performed, action taken, remaining balance, and follow-up timeframe so the next representative can understand the account without repeating your work.

How do I know when to send a denial to Coding?

Send a denial to Coding when resolving it requires someone to choose, change, validate, or defend CPT/HCPCS, ICD-10, modifiers, code pairs, NCCI edits, bundling rules, or documentation-to-code decisions. Do not send administrative denials like COB, eligibility, timely filing, or missing authorization to Coding unless there is a separate coding question.

AppealsBeginner

How do I know when to appeal a denial?

Appeal when the claim is correct as billed, you disagree with the payer decision, and you have evidence that supports payment. Do not appeal a claim that simply needs a billing correction, COB update, eligibility fix, coding correction, or missing information.

AppealsBeginner

How do I submit a reconsideration or appeal by payer?

The submission method depends on the payer and product. UHC and Regence now rely heavily on electronic portal submission, Humana and Aetna support Availity workflows, Premera currently uses provider appeal forms with fax/mail while its Availity rollout is delayed, Medicare uses the responsible MAC, and TRICARE claim appeals have region-specific fax/mail routes.

Denial ManagementBeginner

How do I work my first denial step by step?

Start with the balance and final ERA/EOB, identify the CARC/RARC, review claim history and payer status, decide who owns the problem, choose the correct resolution path, complete the action, then write a note that shows the money, research, action, and follow-up.

All Guides

Denial ManagementBeginner

How do I work a CO-16 denial?

Pull the ERA/EOB and read the accompanying RARC code(s) — they tell you exactly what information is missing. Correct the specific deficiency, submit a corrected claim using frequency code 7, and monitor for payment within 30 days.

Revenue CycleBeginner

How do I read an EOB?

An Explanation of Benefits (EOB) is the patient-facing version of the remittance advice. Start with the patient and claim information section, then review the service line adjustments, identify the payment amount, and check for any CARC/RARC codes that explain reductions or denials.

Denial ManagementBeginner

How do I correct a denied claim?

First determine whether the claim needs a correction or a formal appeal — if information was missing or wrong, submit a corrected claim (frequency code 7). If you disagree with the denial, file an appeal. Fix the specific issue, resubmit, and track the claim to resolution.

AppealsIntermediate

How do I submit an appeal to UHC?

UHC allows 180 days from the remittance date to file a standard appeal. Gather the denial letter, supporting clinical documentation, and a cover letter, then submit via the UHC Provider Portal, fax, or mail. UHC has 30 days to respond to standard appeals.

Prior AuthorizationBeginner

How do I know if a service needs prior authorization?

Check the payer's prior authorization list on their provider portal, search by the specific CPT/HCPCS code, and verify against the patient's plan. Always document the authorization number or the confirmation that no auth was required before rendering the service.

EligibilityBeginner

How do I verify Aetna benefits?

Log in to the Aetna provider portal (Availity), enter the patient's member ID and date of birth, verify coverage status and plan details, check deductible and coinsurance balances, note copay amounts, and verify prior auth requirements. Document everything including the verification reference number.

Denial ManagementIntermediate

How do I work a CO-50 denial?

CO-50 means the payer determined the service was not medically necessary. Review the payer's coverage policy (LCD/NCD), assess whether your clinical documentation supports medical necessity, and either appeal with supporting documentation or issue an ABN and bill the patient.

Claims SubmissionBeginner

How do I resubmit a rejected claim?

A rejection means the claim never entered the payer's adjudication system — it was stopped at the clearinghouse or front-end. Identify the rejection reason from your clearinghouse report, correct the error, and resubmit as a new claim. Rejections do not count against timely filing because the claim was never received by the payer.

CodingIntermediate

How do I use modifier 25?

Modifier 25 indicates that a significant, separately identifiable Evaluation and Management (E/M) service was performed on the same day as a procedure or service. Append it to the E/M code (not the procedure), ensure the documentation supports a separate service, and verify NCCI edits before submitting.

Revenue CycleIntermediate

How do I read an ERA?

An Electronic Remittance Advice (ERA) is the provider-facing electronic version of the payment explanation. Start with the payer and check information, review each claim's payment status, identify CARC and RARC codes at the claim and line level, post payments and adjustments, then reconcile against your original claims.

AppealsIntermediate

How do I submit a payer reconsideration?

Use reconsideration when you want the payer to review a processed claim again without jumping straight to a formal appeal. Confirm the payer offers reconsideration, identify the exact processing issue, submit a concise request with supporting documents through the payer portal or approved channel, save the confirmation number, and follow up within the payer's stated timeframe.

Denial ManagementBeginner

How do I work a denial without calling the payer?

Start with the ERA/EOB, claim status, eligibility, payer policy, and portal tools. Many denials can be resolved through corrected claims, portal reconsiderations, secure messages, or appeals without a phone call. Call only when the information or action you need is unavailable electronically.

Denial ManagementIntermediate

How do I choose between a corrected claim, reconsideration, appeal, or coding review?

Use a corrected claim when the submitted claim data is wrong, reconsideration when the payer should re-review a processed claim, a formal appeal when you disagree with the payer's coverage or medical necessity decision, and coding review when the resolution depends on CPT, HCPCS, ICD-10, modifier, bundling, or code-pair analysis.

Denial ManagementBeginner

How do I know when to adjust a denied claim?

Do not adjust a balance just because a claim denied. First prove what happened on the final ERA/EOB, reconcile the dollars, and determine whether payment can still be recovered. Adjust only when the payer adjudication or contract supports a provider write-off, no valid recovery path remains, and your organization authorizes the adjustment.

Revenue CycleBeginner

How do I write a strong insurance collections account note?

Use a four-part structure: what happened, what you reviewed or did, why that action was correct, and what happens next. Include the denial reason, key dollar amounts, research performed, action taken, remaining balance, and follow-up timeframe so the next representative can understand the account without repeating your work.

How do I know when to send a denial to Coding?

Send a denial to Coding when resolving it requires someone to choose, change, validate, or defend CPT/HCPCS, ICD-10, modifiers, code pairs, NCCI edits, bundling rules, or documentation-to-code decisions. Do not send administrative denials like COB, eligibility, timely filing, or missing authorization to Coding unless there is a separate coding question.

AppealsBeginner

How do I know when to appeal a denial?

Appeal when the claim is correct as billed, you disagree with the payer decision, and you have evidence that supports payment. Do not appeal a claim that simply needs a billing correction, COB update, eligibility fix, coding correction, or missing information.

AppealsBeginner

How do I submit a reconsideration or appeal by payer?

The submission method depends on the payer and product. UHC and Regence now rely heavily on electronic portal submission, Humana and Aetna support Availity workflows, Premera currently uses provider appeal forms with fax/mail while its Availity rollout is delayed, Medicare uses the responsible MAC, and TRICARE claim appeals have region-specific fax/mail routes.

Denial ManagementBeginner

How do I work my first denial step by step?

Start with the balance and final ERA/EOB, identify the CARC/RARC, review claim history and payer status, decide who owns the problem, choose the correct resolution path, complete the action, then write a note that shows the money, research, action, and follow-up.

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