Get Denial Clarification

curl -X GET "https://api.refactorbilling.com/denial-clarification?tenant_id=1&visit_number=V12345" \
  -H "x-api-key: your-api-key"

{
  "visit_number": "V12345",
  "status": "completed",
  "payer_name": "Aetna",
  "patient_name": "John Doe",
  "claim_status_code": "4",
  "denial_reason": "Service not covered under the patient's current benefit plan.",
  "denial_remark_codes": ["N381", "MA04"],
  "adjustment_codes": [
    {
      "group_code": "CO",
      "reason_code": "50",
      "amount": 750.00,
      "description": "These are non-covered services because this is not deemed a medical necessity by the payer."
    }
  ],
  "recommended_action": "Submit appeal with supporting clinical documentation demonstrating medical necessity."
}

curl -X GET "https://api.refactorbilling.com/denial-clarification?tenant_id=1&visit_number=V12345" \
  -H "x-api-key: your-api-key"

{
  "visit_number": "V12345",
  "status": "completed",
  "payer_name": "Aetna",
  "patient_name": "John Doe",
  "claim_status_code": "4",
  "denial_reason": "Service not covered under the patient's current benefit plan.",
  "denial_remark_codes": ["N381", "MA04"],
  "adjustment_codes": [
    {
      "group_code": "CO",
      "reason_code": "50",
      "amount": 750.00,
      "description": "These are non-covered services because this is not deemed a medical necessity by the payer."
    }
  ],
  "recommended_action": "Submit appeal with supporting clinical documentation demonstrating medical necessity."
}

Authentication

All requests require an API key passed via the x-api-key header, along with a tenant_id query parameter.

string

required

Your tenant API key.

Query Parameters

integer

required

Your tenant ID.

string

required

The visit number to look up denial details for.

Response

string

The visit number that was queried.

string

Call status. One of completed, in_progress, or failed.

string

Name of the payer that issued the denial.

string

Patient name on the denied claim.

string

Claim status code (e.g. 4 = denied).

string

Human-readable explanation of the denial reason.

string[]

Remittance advice remark codes (RARC) associated with the denial, e.g. ["N381", "MA04"].

DenialAdjustment[]

Claim adjustment codes explaining the denial.

Show DenialAdjustment

string

Claim adjustment group code (e.g. CO, PR, OA).

string

Claim adjustment reason code (e.g. 16, 197, 50).

number

Dollar amount of this adjustment.

string

Human-readable description of the adjustment reason code.

string

Suggested next step to resolve the denial (e.g. “Submit appeal with medical records”, “Resubmit with corrected modifier”).

curl -X GET "https://api.refactorbilling.com/denial-clarification?tenant_id=1&visit_number=V12345" \
  -H "x-api-key: your-api-key"

{
  "visit_number": "V12345",
  "status": "completed",
  "payer_name": "Aetna",
  "patient_name": "John Doe",
  "claim_status_code": "4",
  "denial_reason": "Service not covered under the patient's current benefit plan.",
  "denial_remark_codes": ["N381", "MA04"],
  "adjustment_codes": [
    {
      "group_code": "CO",
      "reason_code": "50",
      "amount": 750.00,
      "description": "These are non-covered services because this is not deemed a medical necessity by the payer."
    }
  ],
  "recommended_action": "Submit appeal with supporting clinical documentation demonstrating medical necessity."
}

Getting Started

Data Import

Pre-Service

Claim Follow-Up

Denial Management

Get Denial Clarification

Authentication

Query Parameters

Response

​Authentication

​Query Parameters

​Response

Authentication

Query Parameters

Response