Denied Insurance Claim Checklist

1. Identify the decision

• Save every page of the denial notice and EOB.
• Match the patient, member ID, provider, service date, and claim or authorization number.
• Record the denial reason and date you received the notice.
• Identify your plan type and read its appeal instructions.

2. Protect the timeline

• Write down the filing deadline and where the appeal must go.
• Set a reminder early enough to gather missing records.
• Ask whether a corrected claim or provider review affects your appeal rights.
• If ongoing or urgent care is affected, ask about faster review and any continuation rules.

3. Choose the response

• For missing or incorrect claim details, ask the provider for a billing review.
• For clinical criteria, involve the treating clinician.
• For authorization issues, obtain the request and approval history.
• For network issues, check the provider, facility, plan, and service date.

4. Build and send the packet

• Write a short explanation addressing the denial’s actual reason.
• Attach relevant records and any required forms.
• Complete representative authorization if someone will act for you.
• Use the approved channel and save a complete copy with proof of submission.

5. Track insurance and billing separately

• Confirm receipt and obtain an appeal reference number.
• Ask when to expect a decision and record follow-up dates.
• Ask the provider for a billing hold and written confirmation.
• Open new notices promptly; do not assume all deadlines have paused.

6. Close the loop

If the claim is reprocessed, compare the new EOB with an updated provider statement. Confirm any remaining balance or refund. If the decision stays denied, review further appeal or external review instructions. A complaint can help raise a problem, but may not replace an appeal.