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Training Simulator

Denial Resolution
Training Simulator

Practice resolving real-world insurance denials in a realistic EHR-inspired environment. Receive mock patient accounts, investigate claims, determine responsibility, choose the correct workflow, and get graded on every step — with detailed explanations.

Browse Training Cases How It Works

How It Works

Six steps from patient chart to graded resolution — every decision matters.

Step 1

Receive Mock Patient Account

Get a realistic patient chart with demographics, insurance, claims, and denial history.

Step 2

Investigate the Denial

Review EOBs, eligibility, claim details, activity logs, and payer correspondence.

Step 3

Determine Responsible Party

Analyze the root cause — was it the provider, payer, patient, or clearinghouse?

Step 4

Choose Correct Workflow

Decide: corrected claim, appeal, write-off, or bill patient — and document your reasoning.

Step 5

Submit Resolution

Select the specific resolution action and submit for grading.

Step 6

Get Graded & Learn

Every step is scored with detailed explanations of why each answer is correct or incorrect.

Available Training Cases

Each case includes a complete mock patient chart with realistic denial data. Choose a case to start investigating.

BeginnerCoding Error

CO-16: Missing Modifier on E/M + Procedure

A claim for an office visit and ECG was denied for missing modifier 25. Investigate the denial, identify the responsible party, and choose the correct resolution workflow.

Family Medicine 15 min 5 steps

CO-16Start Case

IntermediateMedical Necessity

CO-50: Medical Necessity — MRI Lumbar Spine

An MRI lumbar spine without contrast was denied as not medically necessary. The patient had 6 weeks of conservative treatment. Investigate and determine the correct resolution.

Orthopedics 20 min 5 steps

CO-50Start Case

IntermediateAuthorization

CO-197: No Prior Authorization — Specialty Drug

An infusion of a specialty biologic drug was denied because prior authorization was not obtained before administration. Investigate and determine the correct resolution.

Rheumatology 18 min 5 steps

CO-197Start Case

Educational Simulation: All patient names, MRNs, claim numbers, and insurance details in this training environment are fictional and created for educational purposes only. No real patient data is used. This simulator is designed to teach denial resolution skills in a safe, practice environment.

Ready to Practice?

Choose a case above and start investigating. Every step is graded with detailed feedback.

Browse Cases

Denial ResolutionTraining Simulator