> ## Documentation Index
> Fetch the complete documentation index at: https://docs.rcintell.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Denial resolution

> Resolve claim denials using CARC/RARC codes and AI-generated appeal strategies

The denial resolution agent analyzes claim denials and generates payer-specific appeal strategies with deadlines and recommended actions.

## Submit a denial

```bash theme={null}
curl -X POST https://api-dev.rcintell.com/v1/agents/denial-resolution \
  -H "X-API-Key: kp_test_..." \
  -H "Content-Type: application/json" \
  -d '{
    "query": "Claim denied for prior authorization not obtained",
    "carc": "197",
    "rarc": "N479",
    "ccn": "170001"
  }'
```

### Request body

| Field         | Type   | Required | Description                           |
| ------------- | ------ | -------- | ------------------------------------- |
| `query`       | string | Yes      | Description of the denial or question |
| `carc`        | string | No       | Claim Adjustment Reason Code          |
| `rarc`        | string | No       | Remittance Advice Remark Code         |
| `denial_code` | string | No       | Denial reason code                    |
| `claim_id`    | string | No       | Original claim identifier             |
| `ccn`         | string | No       | Facility CCN for payer context        |

## Poll for results

When complete, the result includes:

```json theme={null}
{
  "job_id": "550e8400-...",
  "status": "completed",
  "result": {
    "denial_analysis": {
      "carc": "197",
      "carc_description": "Precertification/authorization/notification absent",
      "rarc": "N479",
      "rarc_description": "Missing prior authorization",
      "category": "Prior Authorization"
    },
    "appeal_strategy": {
      "recommended_action": "Submit retro-authorization request, then appeal",
      "steps": [
        "Contact the payer to request a retroactive authorization",
        "Gather clinical documentation supporting medical necessity",
        "Submit a formal appeal with the authorization number",
        "Include a letter of medical necessity from the treating provider"
      ],
      "deadline": "120 days from denial date (Medicare)",
      "appeal_level": "Redetermination",
      "success_likelihood": "moderate"
    },
    "payer_context": {
      "payer": "Medicare",
      "timely_filing": "12 months",
      "appeal_levels": ["Redetermination", "QIC", "ALJ", "Medicare Appeals Council", "Federal District Court"]
    }
  },
  "audit_tier": "green",
  "composite_score": 0.91
}
```

## Common denial scenarios

| CARC | Description                               | Common Resolution              |
| ---- | ----------------------------------------- | ------------------------------ |
| 4    | Procedure code inconsistent with modifier | Correct modifier and resubmit  |
| 16   | Missing information                       | Submit with required data      |
| 18   | Duplicate claim                           | Verify original claim status   |
| 29   | Filing limit expired                      | Check payer-specific deadlines |
| 96   | Non-covered charge                        | Appeal with medical necessity  |
| 197  | Prior auth absent                         | Obtain retro-auth or appeal    |