Neurosurgery

Top denial drivers

• Clinical rationale present in the note but not organized into the structure the reviewer is trained to look for
• Documentation reviewed against last quarter's payer policy instead of the current one
• Cases escalating to peer-to-peer that a complete note would have resolved on first review

What reviewers expect to see

• Documentation mapped to the specific payer's current coverage policy, not a generic template
• Clinical findings organized into the structure each payer's reviewer expects
• Gaps flagged for the physician to review and address as clinically appropriate