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Authentication

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

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Query Parameters

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tenant_id
integer
required
Your tenant ID.
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visit_number
string
required
The visit number to look up denial details for.

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Response

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visit_number
string
The visit number that was queried.
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payer_name
string
Name of the payer that issued the denial.
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patient_name
string
Patient name on the denied claim.
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claim_status_code
string
Claim status code (e.g. 4 = denied).
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denial_reason
string
Human-readable explanation of the denial reason.
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denial_remark_codes
string[]
Remittance advice remark codes (RARC) associated with the denial, e.g. ["N381", "MA04"].
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adjustment_codes
DenialAdjustment[]
Claim adjustment codes explaining the denial.
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recommended_action
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",
  "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."
}