Concept walkthrough · 3 min
How a denial becomes a cited appeal.
Three minutes on a denied bariatric case: the payer policy it is read against, the one piece of documentation missing from the chart, and the reconsideration package that comes out the other side.
Concept walkthrough · illustrative case · no PHIPrefer to read it? The full package →
What it covers
Three minutes, one denied bariatric case — from the stall to a reconsideration that answers every requirement.
0:00
The denial stops everythingCare and reimbursement both stall. A queue delivers the denial to someone’s list — it doesn’t say why the payer said no, or what would overturn it.
0:40
Why it gets written offStaff hunt hundreds of pages of chart against policies that keep moving. The volume beats even experienced reviewers, and unappealed revenue is eventually written off.
1:27
One case, read against the policyA bariatric denial from UnitedHealthcare: the reason is analyzed against the version-tracked UHC policy, and the chart is cross-referenced to its medical-necessity criteria.
2:05
The one missing pieceTwo of three criteria already satisfied — what’s absent is a discrete coded BMI observation, so the provider is told exactly what to record.
2:30
Gap closed, package builtThe record syncs back through Epic SMART on FHIR and the system compiles a reviewer-ready reconsideration that answers every plan requirement.