The tracking view
All submitted appeals live in Appeals → Tracking. Filter by status, payer, assignee, or deadline window.| Status | What it means |
|---|---|
submitted | Appeal filed, awaiting payer response. |
acknowledged | Payer confirmed receipt. |
in_review | Payer has assigned a reviewer. |
additional_info_requested | Payer wants more docs. Action required. |
upheld | Denial upheld (appeal denied). |
overturned | Denial overturned (appeal approved). |
partially_overturned | Partial approval — e.g., a subset of services approved. |
external_review | Escalated to IRO / state regulator. |
closed | Terminal state — no further action. |
Deadline and follow-up reminders
Automatic deadline compute
The payer’s response SLA is computed from the submission date and the specific appeal type (first-level, second-level, external review).
Reminder cascade
- T-14 days: Light reminder in inbox.
- T-7 days: Email + in-app notification to the assignee.
- T-1 day: Escalation to the assignee’s manager.
- T+0: Automatic follow-up task created.
Capturing outcomes
When the payer responds:- If the response is a formal letter — upload it (or let it sync from your EHR/scan-to-email). Denialbase extracts the outcome automatically.
- If the response was verbal (phone, peer-to-peer) — click Record outcome and fill in the fields.
- Final amount approved (if any)
- Reference / claim number
- Notes (e.g. “provider agreed after peer-to-peer”)
- Follow-up needed (e.g. “resubmit with modifier”)
Reporting
Dashboards
Overturn rate by payer, denial type, provider, and strategy. Trend over time. Filterable and exportable.
Per-payer performance
Which payers have the highest overturn rates for your practice? Which are slowest to respond? All sliceable.
Financial recovery
Total dollars recovered this month / quarter / year. By payer, by provider, by billing staff member.
Exports
CSV, XLSX, or JSON. All exports are audit-logged per HIPAA requirements.
Learning loops
Every outcome is fed back into the system in three ways:Strategy model
Strategy model
The overturn-probability estimate for similar future denials is updated based on the actual outcome.
Draft tuning
Draft tuning
If your edits materially changed the submitted letter, those edits inform the drafts for similar future appeals — tuned to your practice’s voice.
Payer playbooks
Payer playbooks
Patterns across many practices — “Kaiser overturns 80% of
coverage_exclusion denials when peer-to-peer is requested” — feed the insurer-specific guides at Insurer guides.External / IRO review
When a first-level appeal is upheld and the amount justifies escalation:- For ERISA plans: external review via an IRO.
- For state-regulated plans: state insurance department review.
- For Medicare/Medicaid: ALJ hearing or state fair hearing.
Exporting the full appeal history
For audit or transition purposes, you can export the complete appeal history for any patient or the whole practice:- Settings → Data → Export → Appeals — generates a downloadable archive (documents + metadata) within 10 minutes.
- Every export is audit-logged per HIPAA §164.312(b).