Dispute Resolution (PDR)
Manage and track claim disputes with payers
✓
File Dispute
2
Initial Review
3
Payer Response
4
Resolution
34
Upheld
18
Overturned
7
Partial
3
Withdrawn
36%
Overturn Rate
Active Disputes (8)
| Dispute ID | Claim ID | Payer | Service Date | Amount | Days Open | Status | |
|---|---|---|---|---|---|---|---|
| DSP-2026-0441 | CLM-2026-08620 |
BlueCross BlueShield | Feb 14, 2026 | $1,240.00 | 18 | Initial Review | |
| DSP-2026-0422 | CLM-2026-08544 |
Aetna Health | Jan 29, 2026 | $680.00 | 31 | Payer Response | |
| DSP-2026-0398 | CLM-2026-08490 |
United Healthcare | Jan 15, 2026 | $425.00 | 44 | Escalated | |
| DSP-2026-0371 | CLM-2026-08401 |
Medicare | Dec 22, 2025 | $2,100.00 | 67 | Payer Response | |
| DSP-2026-0344 | CLM-2025-09180 |
BlueCross BlueShield | Dec 5, 2025 | $360.00 | 9 | Filed | |
| DSP-2025-0901 | CLM-2025-08990 |
Cigna Health | Nov 18, 2025 | $520.00 | 87 | Escalated | |
| DSP-2025-0878 | CLM-2025-08812 |
Medicaid | Nov 3, 2025 | $880.00 | 14 | Initial Review | |
| DSP-2025-0840 | CLM-2025-08700 |
Aetna Health | Oct 21, 2025 | $1,500.00 | 102 | Resolved — Overturned |
DSP-2026-0441 — Detail
Initial Review
CLM-2026-08620
BlueCross BlueShield
February 14, 2026
$1,240.00
Medical Necessity — Denial overrides clinical judgment
March 10, 2026
Supporting Documents
📄 ClinicalNotes_Feb14.pdf
📄 AuthLetter_0441.pdf
📄 MedicalNecessity_Criteria.pdf
Dispute Timeline
- Mar 10, 2026 — Dispute filed by J. Walsh, RN. Reason: Medical Necessity.
- Mar 11, 2026 — Acknowledgment received from BCBS (Reference #BCB-44182)
- Mar 14, 2026 — Payer assigned to Medical Review team (estimated 15 business days)
- Mar 28, 2026 — Awaiting payer response...