Real work, anonymized
Read our work before you send us anything.
These are actual filings and reports, with patient and practice details removed.
Appeal filing · PDF
TRI-124: commercial-payer post-exhaustion escalation
Four claims denied and reversed in full. Contracted payments on the same claims the payer called non-contracted, an authorization denied the next day, and three reasons in 65 days.
Read the filing ↗
Surveillance report · PDF
One practice, one month
Eight denied claims, each mapped to the contradiction, the recoverable amount and the filing path. This is what Surveillance sends every month.
Read the sample ↗
Drug report · PDF
Tepezza J3241
How payers interrupt therapy at Cycle 4 or 5: audiometry holds, weight-rounding caps and site-of-care shifts.
Read the report ↗
Drug report · PDF
Enhertu J9358
Seven denial patterns across major commercial payers, with recovery paths for each.
Read the report ↗
Surgery centers · PDF
ASC adjudication excerpt
APONVIE and EXPAREL denied under CO-97 packaging rules. Neither denial was clinical. Both recoverable.
Read the excerpt ↗
Newsletter
Payer Games
Denial patterns, payer tactics and the arguments that win them back, from the claims we read. Get each issue by email.