Back to playbooks

Quarterly Denial Integrity Review

Use this template for a recurring management review of denial quality, appeal performance, and accountability failures.

Review period

• quarter:
• owner:
• systems included:

Core metrics

• denial volume
• appeal rate
• overturn rate
• time to resolution
• notice quality failures
• categories with the highest reversal rates
• share of adverse actions taken with corroboration
• vendor or program escalation actions

Review questions

• where are denials hardest to understand
• where are records hardest to produce
• which categories show the highest reversal rates
• where is ownership unclear
• which vendors or programs need escalation

Actions

• notice redesign:
• threshold change:
• vendor action:
• appeal staffing or process change:
• leadership escalation:

Back to playbooks