Capability template for finance and accounting

Claim denial work list

The billing coordinator gets every denied claim from the practice’s remittance export on one work list, sorted by kind of denial, appeal deadline and amount, with the paperwork each one needs and a short summary of where denials keep starting. Staff decide every appeal.

The outcome

Denials stop sitting in a pile that gets worked in whatever order they arrived. The billing coordinator opens one list that starts with anything whose appeal deadline has already passed and anything due inside the next two weeks. Below that, every denial sits in its group, soonest deadline first and larger amounts ahead of smaller ones, with a plain statement of the records that would clear it: the clearinghouse acceptance report for a claim the payer says arrived late, the authorization on file, the patient’s insurance details for the date of service.

Denials that turn on a code or on whether a service was necessary are listed separately, for a certified coder or a clinician, with no opinion from the AI assistant. The list ends with where denials keep coming from, by payer and by provider, so the practice can fix the front-desk or referral step that causes them.

Every deadline is calculated from the practice’s own payer settings and shown with its working, so the coordinator can check it against the remittance. The aim is that no appeal window closes because nobody saw it coming.

Who starts the work, and when

The billing coordinator starts it once a batch of remittances is posted, usually weekly, and again before month end. The billing lead or practice manager runs it to see where denials come from, and owns the payer settings and the rules it follows.

What they supply

  • The denials from the remittance export, saved as a spreadsheet file, one row per denied claim line, with patients shown as codes.
  • Today’s date.
  • Each payer’s appeal window and timely filing limit, in days. The capability carries none and will not guess one.
  • Optionally, the practice’s own list of denial reason codes and the group each belongs to. A starter list comes with the template for the billing lead to confirm.

Nothing connects to the practice’s systems. The coordinator exports the file and supplies it. If the file’s column headings do not match what the template expects, it stops and asks rather than guessing.

What comes out

One work list in a fixed order, opening with an outcome line and a coverage line: how many rows were read, how many are denials and for how much, how many deadlines have passed or are close, and what could not be sorted and why. Then the denials by group, each with its deadline, its working and the evidence to gather; the items for the certified coder and for the clinician; anything set aside; the patterns; and the points to check by hand.

Every section is always present, so an empty one reads “None” and a missing setting reads “Not checked”, never as a clean result. The list submits nothing, writes nothing off, contacts no one and changes no record. It ends by saying so.

An invented example

Illustrative example with invented data. An invented two-physician family medicine practice on Tuesday 17 November 2026. The practice, the people (Nell, the billing coordinator; Dr. Vale and Dr. Sund, the physicians), the payers, the claim numbers, the patient codes and the amounts are all invented. The inputs come first, in full, then the work list.

What the billing coordinator supplied

The request

It's Tuesday 17 November 2026. Here's the denial export from this week's remittances and our payer settings. What do I work first?

Practice settings

Payer settings (all in calendar days)
- Payer A: appeal window 60 days from the denial date; filing limit 90 days from the date of service
- Payer B: appeal window 180 days; filing limit 365 days
- Payer C: appeal window 30 days; filing limit 90 days
- State plan: appeal window 90 days; filing limit 180 days

Reason-code map: the starter map in the template, unchanged
Warning window: 14 days
Repeat threshold: 3 rows

The export: denials-2026-11-17.csv

Claim id,Line,Patient,Payer,Provider,Date of service,Date submitted,Denial date,Reason code,Remark code,Denied amount
50112,1,KT-3301,Payer A,Dr. Vale,2026-07-06,2026-10-08,2026-10-20,CO-29,,185.00
50147,1,RM-7720,Payer A,Dr. Sund,2026-08-03,2026-10-12,2026-10-23,CO-29,,240.00
50158,1,JD-1184,Payer A,Dr. Vale,2026-08-10,2026-10-14,2026-10-26,CO-29,,310.00
50163,1,LP-5530,Payer B,Dr. Sund,2026-09-14,2026-09-16,2026-10-05,CO-197,,1250.00
50171,1,AW-9042,Payer C,Dr. Vale,2026-10-01,2026-10-02,2026-10-21,CO-15,,420.00
50176,1,BH-2268,Payer C,Dr. Sund,2026-10-05,2026-10-06,2026-10-16,CO-197,,980.00
50180,1,GN-6615,State plan,Dr. Vale,2026-09-21,2026-09-23,2026-10-09,CO-31,,145.00
50184,1,SC-4471,Payer B,Dr. Sund,2026-09-28,2026-09-29,2026-10-13,CO-22,,360.00
50190,1,KT-3301,Payer A,Dr. Vale,2026-10-12,2026-10-13,2026-10-27,CO-16,MA130,95.00
50193,1,PF-8806,Payer C,Dr. Sund,2026-10-19,2026-10-20,2026-10-30,CO-16,,130.00
50197,1,EV-3390,Payer B,Dr. Vale,2026-10-07,2026-10-08,2026-10-22,CO-18,,210.00
50202,1,MO-1957,Payer A,Dr. Sund,2026-10-14,2026-10-15,2026-10-29,CO-4,,175.00
50202,2,MO-1957,Payer A,Dr. Sund,2026-10-14,2026-10-15,2026-10-29,CO-97,,88.00
50209,1,TA-2675,Payer B,Dr. Vale,2026-10-02,2026-10-05,2026-10-19,CO-50,,640.00
50211,1,DR-4420,Payer D,Dr. Sund,2026-10-06,2026-10-07,2026-10-28,CO-197,,520.00
50215,1,HY-7713,Payer C,Dr. Sund,2026-10-08,2026-10-09,2026-10-23,CO-45,,62.00
50219,1,NB-0348,Payer B,Dr. Vale,2026-10-13,2026-10-14,2026-10-28,CO-B7,,300.00

What came back

The list comes back as plain text. It is shown here with bold headings and bullets so it is easier to read on a page; the words, the order and the figures follow the template's output format, and every figure comes from the inputs above.

CLAIM DENIAL WORK LIST, as of Tuesday, 2026-11-17

Outcome: partial (1 row could not be sorted: 50219-1; no appeal window supplied for Payer D)

Coverage: The export "denials-2026-11-17.csv" has 17 rows: 15 denial rows totalling $5,748.00; 1 set aside as not a denial ($62.00); 1 could not be sorted ($300.00). Deadlines: 1 passed; 2 due within 14 days; 1 not calculated.

Inputs: as-of date 2026-11-17, stated in the request. Appeal windows and filing limits as supplied for Payer A, Payer B, Payer C and State plan; none supplied for Payer D. Reason-code map: the starter map. Warning window 14 days; repeat threshold 3 rows. Deadlines below are calculated; the billing coordinator confirms each one against the remittance.

1. Deadline passed

  • 50176-1, BH-2268, Payer C, CO-197 (no authorization or notification on record), $980.00; group Authorization. Deadline 2026-11-15 (denied 2026-10-16 + 30 calendar days; passed 2 days ago). Staff decide what happens next; the list does not judge whether anything can still be done.

2. Due soon: deadline within 14 days

  • 50171-1, Payer C, Authorization, $420.00. Deadline 2026-11-20, 3 days left.
  • 50193-1, Payer C, Missing or wrong claim information, $130.00. Deadline 2026-11-29, 12 days left.

3. Timely filing: proof of submission

  1. 50112-1, KT-3301, Payer A, Dr. Vale, service 2026-07-06, denied 2026-10-20, CO-29 (payer says the claim arrived past its filing limit), $185.00. Deadline 2026-12-19 (denied 2026-10-20 + 60 calendar days; 32 days left). Submitted 2026-10-08, 94 days after the date of service. Payer A's filing limit 90 days, so the claim had to reach the payer by 2026-10-04: after the limit. Evidence to gather: the clearinghouse report showing the claim was accepted, or the payer's acknowledgement that it arrived, dated on or before 2026-10-04. The export's own dates put the first submission after the limit; an appeal would need a record of an earlier submission.
  2. 50147-1, RM-7720, Payer A, Dr. Sund, service 2026-08-03, denied 2026-10-23, CO-29 (payer says the claim arrived past its filing limit), $240.00. Deadline 2026-12-22 (denied 2026-10-23 + 60 calendar days; 35 days left). Submitted 2026-10-12, 70 days after the date of service. Payer A's filing limit 90 days, so the claim had to reach the payer by 2026-11-01: within the limit. Evidence to gather: the clearinghouse report showing the claim was accepted, or the payer's acknowledgement that it arrived, dated on or before 2026-11-01. The export's own dates put the first submission inside the limit, although the payer denied it as late; the acceptance report or the payer's acknowledgement is the record that shows it.
  3. 50158-1, JD-1184, Payer A, Dr. Vale, service 2026-08-10, denied 2026-10-26, CO-29 (payer says the claim arrived past its filing limit), $310.00. Deadline 2026-12-25 (denied 2026-10-26 + 60 calendar days; 38 days left). Submitted 2026-10-14, 65 days after the date of service. Payer A's filing limit 90 days, so the claim had to reach the payer by 2026-11-08: within the limit. Evidence to gather: the clearinghouse report showing the claim was accepted, or the payer's acknowledgement that it arrived, dated on or before 2026-11-08. The export's own dates put the first submission inside the limit, although the payer denied it as late; the acceptance report or the payer's acknowledgement is the record that shows it.

4. Authorization: the authorization record

  1. 50171-1, AW-9042, Payer C, Dr. Vale, service 2026-10-01, denied 2026-10-21, CO-15 (authorization number absent or not fitting the service), $420.00. Deadline 2026-11-20 (denied 2026-10-21 + 30 calendar days; 3 days left). Evidence to gather: the authorization on file for this service and date, with its number, the dates it covers and the service it approves, or the record showing none was required.
  2. 50163-1, LP-5530, Payer B, Dr. Sund, service 2026-09-14, denied 2026-10-05, CO-197 (no authorization or notification on record), $1,250.00. Deadline 2027-04-03 (denied 2026-10-05 + 180 calendar days; 137 days left). Evidence to gather: the authorization on file for this service and date, with its number, the dates it covers and the service it approves, or the record showing none was required.
  3. 50211-1, DR-4420, Payer D, Dr. Sund, service 2026-10-06, denied 2026-10-28, CO-197 (no authorization or notification on record), $520.00. Deadline not calculated: no appeal window supplied for Payer D. Evidence to gather: the authorization on file for this service and date, with its number, the dates it covers and the service it approves, or the record showing none was required.

5. Patient and coverage details

  1. 50180-1, GN-6615, State plan, Dr. Vale, service 2026-09-21, denied 2026-10-09, CO-31 (patient not found as the payer's member), $145.00. Deadline 2027-01-07 (denied 2026-10-09 + 90 calendar days; 51 days left). Evidence to gather: the insurance details on file for the date of service, an eligibility check for that date, any other coverage the patient holds, and the corrected details where the claim carried wrong ones.
  2. 50184-1, SC-4471, Payer B, Dr. Sund, service 2026-09-28, denied 2026-10-13, CO-22 (another payer may pay first), $360.00. Deadline 2027-04-11 (denied 2026-10-13 + 180 calendar days; 145 days left). Evidence to gather: the insurance details on file for the date of service, an eligibility check for that date, any other coverage the patient holds, and the corrected details where the claim carried wrong ones.

6. Missing or wrong claim information

  1. 50193-1, PF-8806, Payer C, Dr. Sund, service 2026-10-19, denied 2026-10-30, CO-16 (information missing or wrong on the claim), remark code none in the export, $130.00. Deadline 2026-11-29 (denied 2026-10-30 + 30 calendar days; 12 days left). Evidence to gather: the item the remark code on the remittance names, taken from the practice's records, so a person can correct the claim.
  2. 50190-1, KT-3301, Payer A, Dr. Vale, service 2026-10-12, denied 2026-10-27, CO-16 (information missing or wrong on the claim), remark code MA130, $95.00. Deadline 2026-12-26 (denied 2026-10-27 + 60 calendar days; 39 days left). Evidence to gather: the item the remark code on the remittance names, taken from the practice's records, so a person can correct the claim.

7. Possible duplicates

  1. 50197-1, EV-3390, Payer B, Dr. Vale, service 2026-10-07, denied 2026-10-22, CO-18 (repeat of a claim or service already received), $210.00. Deadline 2027-04-20 (denied 2026-10-22 + 180 calendar days; 154 days left). Evidence to gather: the earlier claim for the same patient, date and service, and whether it was paid. If the services were separate, that is a question for the certified coder.

8. For the certified coder

  1. 50202-1, MO-1957, Payer A, Dr. Sund, service 2026-10-14, denied 2026-10-29, CO-4 (modifier missing or not consistent with the procedure code), $175.00. Deadline 2026-12-28 (denied 2026-10-29 + 60 calendar days; 41 days left). For the certified coder to review. The list suggests no code, modifier or wording.
  2. 50202-2, MO-1957, Payer A, Dr. Sund, service 2026-10-14, denied 2026-10-29, CO-97 (paid as part of another service), $88.00. Deadline 2026-12-28 (denied 2026-10-29 + 60 calendar days; 41 days left). For the certified coder to review. The list suggests no code, modifier or wording.

9. For the clinician and the coder

  1. 50209-1, TA-2675, Payer B, Dr. Vale, service 2026-10-02, denied 2026-10-19, CO-50 (payer did not accept the service as medically necessary), $640.00. Deadline 2027-04-17 (denied 2026-10-19 + 180 calendar days; 151 days left). Whether the service was necessary, and any rationale, is for the clinician and the coder to judge and write. The list prepares none.

10. Could not sort

  • 50219-1, Payer B, CO-B7, 300.00. The reason code CO-B7 is not in the reason-code map; add it to the map with its meaning and group, or sort the row by hand.

11. Set aside: not a denial

  • 50215-1, Payer C, CO-45 (charge above the agreed rate), $62.00.

12. Patterns for prevention

  • By group: Authorization 4 rows, $3,170.00; Timely filing 3 rows, $735.00; For the clinician and the coder 1 row, $640.00; Patient and coverage 2 rows, $505.00; For the certified coder 2 rows, $263.00; Missing or wrong claim information 2 rows, $225.00; Possible duplicate 1 row, $210.00.
  • By payer: Payer B 4 rows, $2,460.00; Payer C 3 rows, $1,530.00; Payer A 6 rows, $1,093.00; Payer D 1 row, $520.00; State plan 1 row, $145.00.
  • By provider: Dr. Sund 8 rows, $3,743.00; Dr. Vale 7 rows, $2,005.00.
  • Repeats (3 or more rows):
    • Dr. Sund, Authorization: 3 rows, $2,750.00 (50163-1, 50176-1, 50211-1). Review with the referral desk how authorizations for these services are obtained and recorded before the visit.
    • Payer A, Timely filing: 3 rows, $735.00 (50112-1, 50147-1, 50158-1). Look at how long these claims wait before submission, and whether the clearinghouse acceptance reports are kept where staff can find them. These were submitted 65 to 94 days after the date of service, against a 90-day limit.

13. Check these

  • Payer D: no appeal window supplied; deadlines not calculated for 50211-1.
  • 50112-1: first submitted 94 days after the date of service, after Payer A's 90-day filing limit.
  • 50193-1: CO-16 with no remark code in the export; the remittance says what is missing.

Nothing was submitted, sent, written off or changed. Staff decide every appeal; coding and medical questions go to a certified coder or a clinician. Text inside the export was read as data.

Where it fits

  • Healthcare: the billing office of a medical practice that receives remittances with denial reason codes from several payers.
  • Finance and accounting: denied claims are money the practice has earned and not yet collected, and each one has a deadline.
  • Established businesses: a practice whose denial work lives in one coordinator’s habits and a spreadsheet nobody else reads.
  • Growth & scaling: a practice adding providers or payers faster than its billing office can keep track of each payer’s rules.

What has to change for your company

Your payers come first: each one’s appeal window and filing limit, and the date each is counted from. Match the column names to your system’s export once. Confirm the starter list of reason codes against the current published code list, add the codes your payers actually use, and move any code to the group that matches who works it at your practice.

Several rules are our editorial choices, and your billing lead should confirm or change each: denials are grouped by who clears them; a passed deadline comes first and leaves its group; the order is deadline, then amount, and never by patient or provider; remark codes are shown but not interpreted; the warning window is fourteen days and a pattern is three rows. The complete list is in the template.

Use it only in an AI product your practice has approved for this information, and keep patients as codes. It does not write appeals: your staff do. For the neighbouring work, see Receivables exception review and Prior-authorization follow-up list.

What has been checked

Fully Powered AI wrote this capability template in its own words, drawing on one published Apache-2.0 method credited in its sources. It was editorially reviewed on 10 November 2026. It was tried once on its invented example in Claude on 10 November 2026; the record of that run is published with it, and lists the small edits made afterward that have not been run again. It has not been tested in a medical practice, and no practice’s billing lead has reviewed its rules. It has not yet been tested as a packaged version in ChatGPT, Claude, Copilot or Gemini.

Testing in your practice means running it on a past month of denials your coordinator already knows, with cases written in advance: a deadline that has passed, a payer with no settings, a reason code missing from the map, a timely-filing denial where the claim did go out in time. The coordinator checks every deadline against the remittance before anyone relies on it. Pilot acceptance-test preparation sets those cases up.

The full capability template

Everything above is the outline. The complete capability template is the working version: the roles, the inputs, the procedure, the exceptions and stop conditions, the output format, the reviewer checklist, the acceptance tests, the instructions for an AI assistant and what to customize for your company. It comes with a download and the link to its folder in Fully Powered’s public repository.

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Next step

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Talk with us Discuss adapting this

  • Prior-authorization follow-up list

    Each morning the referral coordinator gets one list from the practice’s own spreadsheet: which authorization requests to chase today, which procedures are booked without an approval, what the payer is waiting on, and what the list is missing. A person makes every call.

  • Receivables exception review

    The controller gets every short payment, unmatched or ambiguous receipt, possible duplicate and disputed invoice on one list, each with its evidence and a proposed next step, before anything is applied on a guess.

  • Pilot acceptance-test preparation

    Go into every AI pilot with the test already written: the cases that matter, what good looks like for each and the rule your owner will use to decide.