Interpret the remit
Group 835 ERA adjustments using group codes, CARCs, and RARCs, then pair the denial with the original claim and payer response.
Service 08 / 09
Denial management
Denials are not one queue with one answer. FERO helps classify recurring issues, collect supporting details, and put the right cases in front of the right people.
Denial triageAppeal preparationPayment review
The challenge
Details matter. So does momentum.
Denial codes, payer messages, claim history, and deadlines often live in different places. The administrative work of assembling them can slow the response.
Turn scattered denial signals into organized work your specialists can act on.
Where robot workers fit
A defined job for every step.
Tasks are mapped to the systems and controls in your environment. People review exceptions and remain accountable for decisions.
Build a work packet
Bring together service dates, submission history, adjustment details, documentation status, and the applicable next-action window.
Track the response
Route correction, reconsideration, or appeal preparation to a specialist and keep the owner and follow-up date visible.
Operational blueprint
What goes in. What comes back.
A useful worker has known inputs, an exception path, and measures that reveal whether the process is helping.
Inputs to connect
- 835 ERA or paper remit details
- CARC, RARC, and group codes
- Original claim and submission history
- Payer-specific response timeframes
Send to a person
- Clinical or coding judgment
- Coverage or medical necessity dispute
- Contract interpretation or patient responsibility decision
Measures to watch
- Denials by root-cause category
- Appeal or correction aging
- Preventable repeat denials
A case in the queue
An ERA reports a missing-information adjustment. The worker groups the adjustment with its remark code and claim history, then routes the packet to a specialist who decides whether to correct or appeal.
The human role
Judgment stays with your team.
Experienced staff decide whether to correct, appeal, write off, or escalate each case and approve any payer-facing response.
The intended result
More room for the work that counts.
The goal is less administrative friction around denial work and clearer insight into patterns worth fixing upstream.
Start with a conversation
Let's talk about denial management.
Tell us where work gets stuck. We will explore the process, the people involved, and where robot workers can make a useful difference.