Denial Pattern Report
Turn a month or quarter of X12 835 remittances into a denial and adjustment report.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- August
- $50.00 contractual adjustment
- September
- $100.00 medical-necessity adjustment
Result: 2 adjustments total $150.00; the largest category represents 66.7%.
Answer the questions this way to reach that result. Your own answers give your own.
Inputs and output
- What you enter
One or more X12 835 version 5010 files, up to 50 MB each. Payment dates drive the month comparison; raw reason codes remain visible.
- What you get
- Sorted summary tables, latest-month change, an adjustment-level preview, and full or patient-redacted CSV downloads.
What this is
It groups net dollars by the reviewed denial category, raw group and reason code, payer, billing code and rendering provider.
When to use it
Use this to find which adjustments cost the most and whether the latest payment month is improving or worsening. Signed reversal adjustments reduce the same bucket instead of being counted as new losses.
How this is calculated
Citation
CMS Medicare FFS 005010X221A1 Health Care Claim Payment/Advice companion guide for 835 structure; category grouping reuses the project-original reviewed CARC mapping from Denial Next Step. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.