Payer Alerts — Community-Reported Denial Patterns

Community-reported payer alerts from billing managers and RCM directors at independent practices. Covers unusual denial pattern spikes, prior authorization policy changes, fee schedule updates, system outages affecting claim processing, and billing incidents. Submissions are reviewed before publication. The alerts feed is intended to surface actionable intelligence that does not appear in official payer communications — such as undisclosed clinical editing changes, sudden increases in a specific CARC code, or prior auth requirement expansions before the formal policy update is published.

Alert categories: prior authorization expansion (payer adds PA requirement for a procedure or diagnosis that previously did not require it), clinical editing change (payer updates LCD-based coverage criteria or NCCI logic causing new denials), payment reduction (payer reduces contracted rates or changes fee schedule without standard contract amendment notice), system incident (clearinghouse or payer portal outage affecting claim submission or status), and credentialing (payer credentialing system changes causing CO-B7 denial spikes). Workspace users can subscribe to alerts by payer and receive email notification when new alerts are posted for their payer mix.

• Payer intelligence — prior authorization requirements and denial profiles
• Prompt pay statutes — enforce payment timelines
• Appeal Letter Builder — respond to new denial patterns