Sample pack · Sample Pediatric ABA Clinic (fictional)
Sample Denial Pack for Billing Companies
This is what you get back for one client: every denial from their 835 remits, sorted by appeal deadline, with a drafted appeal or corrected claim for each. Remits Sep 8, 2026 to Oct 24, 2026, Applied behavior analysis (ABA) and behavioral health, CA.
Denied lines
18
of 40 claims
Denied dollars
$6,455
plus $796 patient responsibility
Closing in 30 days
0
appeal windows to work first
Top categories
- Prior authorization4 · $1,498
- Medical necessity3 · $1,295
- Missing/invalid info4 · $1,193
Worklist, sorted by deadline
Click a line to read its draft, why it was denied, and the next step.
- Mar 11, 2027$561.60128 days left
CO-CO-197 · CPT 97153
Aetna · Prior authorization
AppealhighParitydraftPatient A01 · Claim SYN00001 · DOS Aug 22, 2026 · CPT 97153 × 24 · Remit Sep 12, 2026
- Why it was denied
- CO-197: Precertification/authorization/notification/pre-treatment absent.
- Next step
- Gather the supporting records listed in the drafted letter and submit the appeal/reconsideration before the deadline. Code guide: https://undeny.ai/denial-codes/co-197
Appeal - CO-197 (Prior authorization) - SYN00001
Parity[PRACTICE LETTERHEAD] [DATE] To: Aetna - Provider Appeals / Claim Reconsideration [PAYER APPEALS ADDRESS OR FAX] Patient: Patient A01 Member ID: ZZ0000001 DOB: [DOB] Claim number: SYN00001 Payer claim #: PCN26900037 Date of service: 2026-08-22 Procedure: 97153-HM x 24 unit(s) Billed: $720.00 Paid: $0.00 Denied: $561.60 Denial: CO-197 Rendering provider: [RENDERING PROVIDER NAME, CREDENTIALS], NPI [NPI] RE: Request for reconsideration of denial CO-197 To whom it may concern: We are requesting reconsideration of the denial of 97153 provided on 2026-08-22 ($561.60 denied with CO-197). This request is submitted within the appeal window (180 days from Initial claim decision (Aetna Reconsideration)). Authorization for this service was [obtained under authorization number [AUTH #], valid [AUTH DATES] / requested on [DATE] / not required under the member's plan for this service]. [Attach the authorization approval or request confirmation.] If authorization was not on file, we request retroactive review: the service was medically necessary and [explain why authorization could not be obtained in advance]. Because this claim is for mental health or substance use disorder services, we also ask the plan to confirm its compliance with the Mental Health Parity and Addiction Equity Act (29 U.S.C. § 1185a; 29 CFR 2590.712; 45 CFR 146.136), to the extent the plan is subject to it. Any nonquantitative treatment limitation applied to this service, including prior authorization, concurrent review or medical necessity criteria, must be comparable to, and applied no more stringently than, the limitation applied to medical/surgical benefits in the same classification. Please provide the medical necessity criteria used in this determination, which must be made available to contracting providers on request (29 CFR 2590.712(d)(1)). On behalf of the member [attach authorized representative designation], we also request the plan's comparative analysis for this limitation under ERISA § 712(a)(8). If the plan cannot show the limitation was applied comparably, we ask that the claim be reprocessed for payment. Enclosed: [copy of the remittance advice], [session notes for the date of service], [treatment plan], [authorization record, if any], [any other supporting documentation]. Please reprocess this claim for payment. If the denial is upheld, please provide the specific clinical criteria and plan provisions relied on, and the name and credentials of the reviewer. Sincerely, [NAME], [TITLE] [PRACTICE NAME] | [PHONE] | [EMAIL]
Draft for your biller to review and approve. Nothing is sent without sign-off.
- Mar 21, 2027$748.80138 days left
CO-CO-50 · CPT 97153
Cigna · Medical necessity
AppealhighParitydraft - Mar 21, 2027$171.60138 days left
CO-CO-119 · N130 · CPT 90837
Cigna · Benefit limit
AppeallowParitydraft - Apr 8, 2027$936156 days left
CO-CO-151 · CPT 97153
Aetna · Benefit limit
AppealhighParitydraft - Apr 8, 2027$171.60156 days left
CO-CO-50 · CPT 90837
Aetna · Medical necessity
AppeallowParitydraft - Apr 8, 2027$140.40156 days left
CO-CO-16 · MA130 · CPT 97156
Aetna · Missing/invalid info
Corrected claimlowParitydraft - Apr 18, 2027$280.80166 days left
CO-CO-197 · N54 · CPT 97155
Cigna · Prior authorization
AppealmediumParitydraft - Sep 8, 2027$480309 days left
CO-CO-29 · CPT 97153
UnitedHealthcare · Timely filing
AppealmediumParitydraft - Sep 8, 2027$280.80309 days left
CO-CO-197 · CPT 97155
UnitedHealthcare · Prior authorization
AppealmediumParitydraft - Sep 18, 2027$374.40319 days left
CO-CO-16 · N290 · CPT 97151
Anthem Blue Cross · Missing/invalid info
Corrected claimmediumParitydraft - Sep 18, 2027$374.40319 days left
CO-CO-50 · CPT 97151
Anthem Blue Cross · Medical necessity
AppealmediumParitydraft - Sep 26, 2027$374.40327 days left
CO-CO-197 · CPT 97151
CalOptima Health (Medi-Cal managed care) · Prior authorization
AppealmediumParitydraft - Sep 26, 2027$374.40327 days left
CO-CO-27 · CPT 97153
CalOptima Health (Medi-Cal managed care) · Eligibility
Verify eligibilitymediumParity - Oct 6, 2027$468337 days left
CO-CO-16 · MA130 · CPT 97153
UnitedHealthcare · Missing/invalid info
Corrected claimmediumParitydraft - Oct 6, 2027$171.60337 days left
CO-CO-18 · CPT 90837
UnitedHealthcare · Duplicate
Check original claimlowParity - Oct 16, 2027$140.40347 days left
CO-CO-97 · CPT 97156
Anthem Blue Cross · Bundling
Corrected claimlowParitydraft - Oct 24, 2027$210.60355 days left
CO-CO-16 · N290 · CPT 97155
CalOptima Health (Medi-Cal managed care) · Missing/invalid info
Corrected claimmediumParitydraft - Oct 24, 2027$195355 days left
CO-CO-22 · CPT 90791
CalOptima Health (Medi-Cal managed care) · Coordination of benefits
Bill secondarylowParity
| Deadline | Payer | CARC / RARC | CPT | Denied | Category | Action | Priority |
|---|---|---|---|---|---|---|---|
Mar 11, 2027 128 days left | Aetna | CO-CO-197 Parity | 97153 | $561.60 | Prior authorization | Appeal draft ready | high |
Patient A01 · Claim SYN00001 · DOS Aug 22, 2026 · CPT 97153 × 24 · Remit Sep 12, 2026
Appeal - CO-197 (Prior authorization) - SYN00001Parity[PRACTICE LETTERHEAD] [DATE] To: Aetna - Provider Appeals / Claim Reconsideration [PAYER APPEALS ADDRESS OR FAX] Patient: Patient A01 Member ID: ZZ0000001 DOB: [DOB] Claim number: SYN00001 Payer claim #: PCN26900037 Date of service: 2026-08-22 Procedure: 97153-HM x 24 unit(s) Billed: $720.00 Paid: $0.00 Denied: $561.60 Denial: CO-197 Rendering provider: [RENDERING PROVIDER NAME, CREDENTIALS], NPI [NPI] RE: Request for reconsideration of denial CO-197 To whom it may concern: We are requesting reconsideration of the denial of 97153 provided on 2026-08-22 ($561.60 denied with CO-197). This request is submitted within the appeal window (180 days from Initial claim decision (Aetna Reconsideration)). Authorization for this service was [obtained under authorization number [AUTH #], valid [AUTH DATES] / requested on [DATE] / not required under the member's plan for this service]. [Attach the authorization approval or request confirmation.] If authorization was not on file, we request retroactive review: the service was medically necessary and [explain why authorization could not be obtained in advance]. Because this claim is for mental health or substance use disorder services, we also ask the plan to confirm its compliance with the Mental Health Parity and Addiction Equity Act (29 U.S.C. § 1185a; 29 CFR 2590.712; 45 CFR 146.136), to the extent the plan is subject to it. Any nonquantitative treatment limitation applied to this service, including prior authorization, concurrent review or medical necessity criteria, must be comparable to, and applied no more stringently than, the limitation applied to medical/surgical benefits in the same classification. Please provide the medical necessity criteria used in this determination, which must be made available to contracting providers on request (29 CFR 2590.712(d)(1)). On behalf of the member [attach authorized representative designation], we also request the plan's comparative analysis for this limitation under ERISA § 712(a)(8). If the plan cannot show the limitation was applied comparably, we ask that the claim be reprocessed for payment. Enclosed: [copy of the remittance advice], [session notes for the date of service], [treatment plan], [authorization record, if any], [any other supporting documentation]. Please reprocess this claim for payment. If the denial is upheld, please provide the specific clinical criteria and plan provisions relied on, and the name and credentials of the reviewer. Sincerely, [NAME], [TITLE] [PRACTICE NAME] | [PHONE] | [EMAIL] Draft for your biller to review and approve. Nothing is sent without sign-off. | |||||||
Mar 21, 2027 138 days left | Cigna | CO-CO-50 Parity | 97153 | $748.80 | Medical necessity | Appeal draft ready | high |
Mar 21, 2027 138 days left | Cigna | CO-CO-119 N130 Parity | 90837 | $171.60 | Benefit limit | Appeal draft ready | low |
Apr 8, 2027 156 days left | Aetna | CO-CO-151 Parity | 97153 | $936 | Benefit limit | Appeal draft ready | high |
Apr 8, 2027 156 days left | Aetna | CO-CO-50 Parity | 90837 | $171.60 | Medical necessity | Appeal draft ready | low |
Apr 8, 2027 156 days left | Aetna | CO-CO-16 MA130 Parity | 97156 | $140.40 | Missing/invalid info | Corrected claim draft ready | low |
Apr 18, 2027 166 days left | Cigna | CO-CO-197 N54 Parity | 97155 | $280.80 | Prior authorization | Appeal draft ready | medium |
Sep 8, 2027 309 days left | UnitedHealthcare | CO-CO-29 Parity | 97153 | $480 | Timely filing | Appeal draft ready | medium |
Sep 8, 2027 309 days left | UnitedHealthcare | CO-CO-197 Parity | 97155 | $280.80 | Prior authorization | Appeal draft ready | medium |
Sep 18, 2027 319 days left | Anthem Blue Cross | CO-CO-16 N290 Parity | 97151 | $374.40 | Missing/invalid info | Corrected claim draft ready | medium |
Sep 18, 2027 319 days left | Anthem Blue Cross | CO-CO-50 Parity | 97151 | $374.40 | Medical necessity | Appeal draft ready | medium |
Sep 26, 2027 327 days left | CalOptima Health (Medi-Cal managed care) | CO-CO-197 Parity | 97151 | $374.40 | Prior authorization | Appeal draft ready | medium |
Sep 26, 2027 327 days left | CalOptima Health (Medi-Cal managed care) | CO-CO-27 Parity | 97153 | $374.40 | Eligibility | Verify eligibility | medium |
Oct 6, 2027 337 days left | UnitedHealthcare | CO-CO-16 MA130 Parity | 97153 | $468 | Missing/invalid info | Corrected claim draft ready | medium |
Oct 6, 2027 337 days left | UnitedHealthcare | CO-CO-18 Parity | 90837 | $171.60 | Duplicate | Check original claim | low |
Oct 16, 2027 347 days left | Anthem Blue Cross | CO-CO-97 Parity | 97156 | $140.40 | Bundling | Corrected claim draft ready | low |
Oct 24, 2027 355 days left | CalOptima Health (Medi-Cal managed care) | CO-CO-16 N290 Parity | 97155 | $210.60 | Missing/invalid info | Corrected claim draft ready | medium |
Oct 24, 2027 355 days left | CalOptima Health (Medi-Cal managed care) | CO-CO-22 Parity | 90791 | $195 | Coordination of benefits | Bill secondary | low |
Verify marks a deadline not yet confirmed against the payer's current policy. Parity marks a behavioral health denial where a Mental Health Parity (MHPAEA) argument applies.
How it works
- Step 1
Upload one client's 835s
The remittance files you already download from the clearinghouse. Nothing to install.
- Step 2
Worklist + drafts in 2 business days
Every denial sorted by appeal deadline, each with a drafted appeal or corrected claim.
- Step 3
Your billers approve
Nothing goes to a payer without your team's sign-off.
- Step 4
We track deadlines
Every open denial stays on the list until it is paid or closed.
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Start with one client's 835s. You get the worklist and drafts in 2 business days, and your billers decide what goes out.