After upload, every denial lands in the Denials inbox with an AI-extracted classification, deadline, and strategy recommendation. Your job is to review, adjust, and approve — not re-enter the data.
The inbox view
The inbox shows one row per detected denial with these columns:| Column | What it means |
|---|---|
| Patient | From the EOB or claim. PHI columns are masked in list views (e.g. J***n D***). |
| Claim ID | As extracted from the document. |
| Payer | Matched to your payer list. |
| Denied amount | From the claim. |
| Denial type | Classified into one of 10 categories (see below). |
| Deadline | Days until the appeal deadline. Red if < 7 days. |
| Confidence | AI confidence in the classification. |
| Status | New, Reviewing, Appealed, Outcome. |
Denial types
| Type | Examples |
|---|---|
medical_necessity | ”Service not medically necessary”, “experimental/investigational” |
prior_authorization | ”No prior auth on file”, “auth denied” |
coding_error | ”Invalid CPT/HCPCS”, “bundling edit”, “unbundling” |
timely_filing | ”Claim submitted after filing deadline” |
out_of_network | ”Provider out of network” |
coverage_exclusion | ”Service not a covered benefit” |
coordination_of_benefits | ”COB information needed” |
patient_responsibility | ”Applied to deductible”, “patient responsibility” |
duplicate | ”Duplicate claim” |
other | Anything we couldn’t confidently bucket |
Confidence score
| Score | What we do |
|---|---|
| ≥ 85% | Auto-route to your inbox as “Ready for review”. |
| 70–84% | Flagged “Check — medium confidence”. The AI is reasonably sure, but you’ll see an extra warning. |
| < 70% | Routed to Human-in-the-loop review (see below). Not surfaced to your inbox until reviewed. |
Human-in-the-loop review
Denials below 70% confidence — or where the AI detects conflicting signals — are automatically queued for review by a trained Denialbase reviewer.Triage
The reviewer reads the document, confirms or corrects the classification, and adjusts the deadline if needed.
Notes
The reviewer adds any context (e.g. “payer used an unusual CARC code; reclassifying as prior-auth based on attached letter”).
Adjusting a classification
You can override the AI on any denial:- Click the Type dropdown on the detail view to reclassify.
- Edit the Deadline if the AI picked it up incorrectly.
- Add Clinical notes that won’t change the appeal draft but will be visible to reviewers and to the AI on re-run.
Bulk actions
Assign
Select multiple denials → Assign to → pick a teammate. Assignees get an email and in-app notification.
Prioritize
Mark as Urgent, Normal, or Low. Urgent denials are pinned to the top of everyone’s inbox.
Snooze
Hide until a specific date. Denials unhide automatically a week before the appeal deadline.
Archive
Archive if you’ve decided not to appeal. Archived denials are included in reporting but out of the main inbox.
Reading the strategy recommendation
For each denial, you’ll see a Strategy box with:- Recommended path: peer-to-peer, formal written appeal, external/IRO review, or “do not appeal” (e.g. duplicate, valid patient responsibility).
- Citations: specific plan language, state regulations, or federal rules (ERISA, ACA) supporting the appeal.
- Estimated overturn probability: based on historical outcomes for similar denials in your practice and the broader Denialbase dataset.
- Prerequisites: e.g. “attach operative report and medical necessity letter before filing”.
The strategy is advisory. You’re always in control of what to appeal and how — the AI’s job is to show you the path with the evidence, not make the decision.