Denials and appeals

“Why was this denied, and what do we do about it?”

The Denials and appeals workflow reads each denial's codes and sorts it by cause, so "denied because of X" can trigger "do Y". When an appeal is the right move, Daybook drafts the letter from the denial data for a biller to review and send. When it isn't, it says why.

Build this with AIA brief with this workflow's endpoints, events and docs, ready for your assistant to scaffold the integration in your stack.

At a glance

Workflow: Denials and appeals
Stage: After a denial on a 277 or 835
Primary users: Denial management and appeals teams
Core question: Why was this denied, and what do we do about it?
Inputs: CARC · RARC · Claim and remit data
Outputs: Cause · Recommended action · Appeal letter
Consumption options: API · Webhooks · MCP

What this workflow enables

Sort every denial by cause: authorization, eligibility, coding, timely filing, duplicate and more.
Get a recommended next step for each one.
Trigger your own rules from the cause, such as a portal attachment for missing records.
Draft the appeal letter for a biller to review and send.

Typical flow

Denial arrives
On a remit or a status change. Daybook reads the CARC and RARC codes.
Classified
denial.classified with the cause, the recommended action and the appeal deadline.
Your rules act
Route by cause: appeal, correct and resubmit, call the payer, bill the patient or secondary.
Appeal drafted
POST /v1/appeals. appeal.drafted when the letter is ready for review.

Step through it

Step 2 of 4: Classified, sends denial.classified

denial.classified

{
  "id": "evt_01JBXT6A4C6E8G0J2M4P6R8T0W",
  "type": "denial.classified",
  "created_at": "2026-10-22T09:15:04Z",
  "mode": "live",
  "data": {
    "id": "den_01JBXG2N5R8W",
    "claim": "A-31120-1",
    "codes": {
      "group": "CO",
      "carc": "197",
      "rarc": [
        "N54"
      ]
    },
    "cause": "missing_auth",
    "recommended_action": "appeal",
    "appeal_deadline": "2027-04-19",
    "amount_cents": 88000
  }
}

Journeys in this workflow

Work denials by causeGroup the queue by why, not by payer.

Appeal missing authDraft the appeal with the auth on file.

Resubmit coding errorsSend the fix back to your billing system.

Watch the deadlineEvery denial carries its appeal deadline.

Use cases

What teams build on this workflow, each with a prompt you can paste into Claude, ChatGPT or Cursor.

Call the payer from your denial queueEvery denial a phone call settles gets one, and the rep's answer lands back on the same ticket.Appeal letters drafted from denial dataA drafted appeal waiting for every denial worth fighting, inside its deadline.A Claude agent that works your AR listClaude checks each claim, reads the payer's last answer and the denial, and drafts the appeal for a person to approve.

APIs powering this workflow

GET/v1/denials/{id}Retrieve a denial POST/v1/appealsDraft an appeal

Events you receive

Subscribe to these with a webhook endpoint. Every event is signed; see Verifying signatures.

Event	Sent when
`denial.classified`	A denial was read and sorted by cause.
`appeal.drafted`	An appeal letter is ready to review, or Daybook refused with the reason.

Example event

{
  "id": "evt_01JBXT6A4C6E8G0J2M4P6R8T0W",
  "type": "denial.classified",
  "created_at": "2026-10-22T09:15:04Z",
  "mode": "live",
  "data": {
    "id": "den_01JBXG2N5R8W",
    "claim": "A-31120-1",
    "codes": {
      "group": "CO",
      "carc": "197",
      "rarc": [
        "N54"
      ]
    },
    "cause": "missing_auth",
    "recommended_action": "appeal",
    "appeal_deadline": "2027-04-19",
    "amount_cents": 88000
  }
}