Free Template · Medical & Healthcare
Denial Management Workflow SOP
A standard workflow for working denied claims — identify, categorize, root-cause, correct, appeal, track, and prevent — with triage owners and turnaround targets.
What's inside
- 7-step denial workflow
- Triage targets by denial type
- Owners + turnaround times
- Prevention feedback loop
Format: PDF · 1 page · Free to use and adapt.
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Preview
Inside the template: The Workflow
A standard workflow your billing staff can follow for every denied claim.
The Workflow
- 1. Identify — pull denials daily from the clearinghouse/ERA
- 2. Categorize — by reason code (eligibility, coding, auth, timely filing)
- 3. Root-cause — front-desk, coding, or payer issue?
- 4. Correct & resubmit — within [48 hours]
- 5. Appeal — with documentation when warranted
- 6. Track — log outcome and turnaround
- 7. Prevent — feed patterns back to intake/coding
The full PDF continues with: Triage Targets.
How to use it
Three steps
- Download the PDF (email-gated, free) and open it alongside the process or agreement you already have.
- Read the sections in order (it opens with "The Workflow"); adapt the wording to your systems and jurisdiction, and mark anything your counsel or compliance officer must confirm.
- Have the responsible person (compliance officer, supervising attorney) review the adapted version before it goes into use — the template is not legal, compliance or medical-billing advice.
Need the person, not just the template?
Hire a remote denial management specialist →Someone whose whole job is working this SOP every day — from $7/hour.
Denial Management Workflow SOP — FAQs
A standard workflow for working denied claims — identify, categorize, root-cause, correct, appeal, track, and prevent — with triage owners and turnaround targets. It is organised into 2 sections — The Workflow; Triage Targets — and covers 7-step denial workflow, Triage targets by denial type, Owners + turnaround times, Prevention feedback loop. Format: PDF, one page, free to use and adapt.
Practice managers, billing leads and RCM directors at clinics, physician groups and billing companies — anyone running or outsourcing revenue-cycle work.
Yes. It is free — we ask for a work email so we can send the download link. It ships as a PDF you can print or copy into your own document; adapt it freely for internal use. It is provided for planning and is not legal, financial, tax or compliance advice.
No template is compliant by itself — compliance depends on how your organisation implements and enforces it. Use it as a starting point with your compliance officer. Zedtreeo's own remote billing staff work under our operator's ISO 27001:2022-certified ISMS and inside your systems, so PHI stays where it is.
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