Healthcare
19 columns
100 rows
8 formats

Claims Denials and Rejection Management

This dataset provides comprehensive details on denied and rejected healthcare claims, including denial reason codes, categories, appeal statuses, root cause analyses, rework notes, and recovery efforts. It enables healthcare organizations to analyze denial patterns, optimize revenue cycle processes, and improve claim resolution rates through targeted interventions.

opened 22 times
last updated 2 Nov 2025
by GoMask

The brief that made it

Denial pattern analysis and reporting

Sample rows

preview · 8 of 100 rows · all 19 columns

claim_idstring	final_resolution_statusstring	recovered_amountfloat	denial_reason_codestring	patient_idstring	provider_idstring	payer_idstring	claim_submission_datedate	claim_amountfloat	denial_statusstring	denial_reason_descriptionstring	denial_categorystring	root_cause_analysisstring	appeal_statusstring	appeal_submission_datedate	appeal_resolution_datedate	rework_notesstring	recovery_effortsstring	last_updateddatetime
CLM10001	unpaid	0	CO16	PAT6501	PRV2001	PAY8001	2023-01-20	1275.42	denied	Missing documentation.	documentation	Staff omitted required operative report.	not appealed	blank	blank	Resubmission pending.	Contacted provider for documents.	2023-01-22T14:34:15
CLM10002	written off	0	CO29	PAT6502	PRV2001	PAY8002	2023-02-05	642.58	rejected	Service not covered.	eligibility	Procedure not listed in plan.	not appealed	blank	blank	Patient notified.	Suggested alternate billing.	2023-02-06T10:05:44
CLM10003	paid	1439.99	CO97	PAT6503	PRV2002	PAY8001	2023-03-10	1439.99	denied	Invalid diagnosis code.	coding error	Coder used outdated ICD code.	successful	2023-03-15	2023-03-28	Corrected diagnosis code.	Appeal submitted with corrected code.	2023-03-28T16:11:38
CLM10004	unpaid	0	CO50	PAT6504	PRV2003	PAY8002	2023-04-11	842.5	appealed	Non-covered service.	eligibility	Service not authorized by payer.	in progress	2023-04-15	blank	Appeal submitted.	Patient statement acquired.	2023-04-16T13:42:29
CLM10005	unpaid	0	CO22	PAT6505	PRV2004	PAY8003	2023-05-08	957.33	denied	Patient not eligible.	eligibility	Insurance lapsed before claim date.	not appealed	blank	blank	Eligibility checked; no coverage.	Bill sent to patient.	2023-05-09T09:47:00
CLM10006	unpaid	0	CO45	PAT6506	PRV2001	PAY8004	2023-06-19	1105.76	resolved	Duplicate claim.	other	Claim resubmitted in error.	not appealed	blank	blank	Duplicate claim closed.	No recovery needed.	2023-06-20T12:15:19
CLM10007	partially paid	200	CO31	PAT6507	PRV2002	PAY8002	2023-07-23	1840.13	denied	Patient coverage terminated.	eligibility	Coverage ended prior to procedure.	unsuccessful	2023-07-25	2023-08-01	Appeal denied; bill sent to patient.	Patient contacted for payment.	2023-08-01T17:52:21
CLM10008	unpaid	0	CO4	PAT6508	PRV2003	PAY8003	2023-08-14	624	rejected	Service code missing.	coding error	CPT code omitted.	not appealed	blank	blank	Coding team notified.	Bill corrected, resubmission pending.	2023-08-15T15:27:10
CLM10009	unpaid	0	CO49	PAT6509	PRV2004	PAY8001	2023-09-12	2347.98	appealed	Non-covered service.	authorization	Authorization not obtained.	in progress	2023-09-15	blank	Appeal under review.	Pre-authorization submitted.	2023-09-16T08:26:42
CLM10010	written off	0	CO18	PAT6510	PRV2001	PAY8004	2023-10-17	1100	denied	Exact duplicate claim.	other	Claim submitted twice by error.	not appealed	blank	blank	System flagged duplicate.	Claim voided.	2023-10-18T11:23:34
CLM10011	paid	1582.25	CO24	PAT6511	PRV2002	PAY8002	2023-11-05	1582.25	resolved	Charges not covered.	authorization	Pre-authorization missing.	successful	2023-11-07	2023-11-15	Authorization received.	Appeal processed.	2023-11-15T15:44:05
CLM10012	unpaid	0	CO5	PAT6512	PRV2003	PAY8003	2023-12-10	700.5	denied	Procedure code missing.	coding error	Procedure code not entered.	not appealed	blank	blank	Awaiting coder update.	Awaiting resubmission.	2023-12-11T12:09:39
CLM10013	unpaid	0	CO16	PAT6513	PRV2004	PAY8001	2023-01-13	957.8	appealed	Missing documentation.	documentation	Nursing notes not attached.	in progress	2023-01-16	blank	Appeal submitted.	Requested notes from provider.	2023-01-16T09:32:21
CLM10014	unpaid	0	CO22	PAT6514	PRV2001	PAY8002	2023-02-22	1235.67	denied	Patient not eligible.	eligibility	Policy inactive on date of service.	not appealed	blank	blank	Patient billed directly.	Eligibility checked.	2023-02-23T15:15:18
CLM10015	paid	1845.2	CO97	PAT6515	PRV2002	PAY8003	2023-03-07	1845.2	resolved	Invalid diagnosis code.	coding error	ICD code updated.	successful	2023-03-10	2023-03-21	Diagnosis corrected.	Appeal processed.	2023-03-21T13:05:00
CLM10016	written off	0	CO50	PAT6516	PRV2003	PAY8004	2023-04-24	600	denied	Non-covered service.	authorization	Payer did not authorize.	not appealed	blank	blank	No authorization, claim closed.	Provider notified.	2023-04-25T10:22:17
CLM10017	unpaid	0	CO16	PAT6517	PRV2004	PAY8002	2023-05-03	1577.75	denied	Missing documentation.	documentation	Discharge summary missing.	not appealed	blank	blank	Request for summary sent.	Pending resubmission.	2023-05-04T12:41:59
CLM10018	unpaid	0	CO4	PAT6518	PRV2001	PAY8003	2023-06-26	1711.9	denied	Service code missing.	coding error	Coder omitted CPT.	not appealed	blank	blank	Coding error corrected.	Claim will be resubmitted.	2023-06-28T14:39:07
CLM10019	unpaid	0	CO45	PAT6519	PRV2002	PAY8004	2023-07-10	1192.3	resolved	Duplicate claim.	other	Duplicate due to system error.	not appealed	blank	blank	Claim voided.	No further action.	2023-07-11T08:18:59
CLM10020	written off	0	CO29	PAT6520	PRV2003	PAY8001	2023-08-02	2200	denied	Service not covered.	eligibility	Procedure excluded from plan.	not appealed	blank	blank	Patient advised.	Alternate billing suggested.	2023-08-03T17:51:23

What the 100 rows show

from the 100-row sample

Paid (final resolution status) stands out: mean recovered_amount is 1,462, against 17.6 for the rest.

0.0median recovered_amount
4denial statuses
4appeal statuses
5denial categories
15payers
16providers

Mean recovered_amount by final_resolution_status100 rows

recovered_amount100 rows, in bands of 250

Median 0.0, from 0.0 to 2,188.

denial_reason_code100 rows · top 10 of 22 values

CO-1610
CO169
CO-228
CO-957
CO296
CO-296
CO975
CO225
CO45
CO-185

19 columns by typefrom the column list below

string 13
float 2
date 3
datetime 1

Columns

19 columns in three groups

blueprint · 19 columns
column	type	description	example
Text 13 columns
`claim_id`	string	Unique identifier for the claimunique	CLM10001
`patient_id`	string	Unique identifier for the patient associated with the claim	PAT6501
`provider_id`	string	Unique identifier for the healthcare provider submitting the claim	PRV2001
`payer_id`	string	Unique identifier for the insurance payer	PAY8001
`denial_status`	string	Current status of the denial (e.g., denied, rejected, appealed, resolved)denied · rejected · appealed · resolved	denied
`denial_reason_code`	string	Standardized code indicating the reason for denial or rejection	CO16
`denial_reason_description`	string	Detailed description of the denial reasonoptional	Missing documentation.
`denial_category`	string	Category of the denial (e.g., coding error, eligibility, documentation, authorization)5 values	documentation
`root_cause_analysis`	string	Summary of the root cause analysis performed for the denialoptional	CPT code omitted.
`appeal_status`	string	Status of any appeal made for the denied claim (e.g., not appealed, in progress, successful, unsuccessful)not appealed · in progress · successful · unsuccessful	not appealed
`rework_notes`	string	Notes describing any rework or corrections performed on the claimoptional	Resubmission pending.
`recovery_efforts`	string	Description of actions taken to recover denied revenueoptional	Bill sent to patient.
`final_resolution_status`	string	Final outcome of the claim after all denial and appeal processes (e.g., paid, partially paid, unpaid, written off)paid · partially paid · unpaid · written off	unpaid
Numbers 2 columns
`claim_amount`	float	Total monetary amount of the claim0 or more	1275.42
`recovered_amount`	float	Amount of money recovered after denial resolution or appeal0 or more · optional	0
Dates and times 4 columns
`claim_submission_date`	date	Date when the claim was originally submitted	2023-01-20
`appeal_submission_date`	date	Date when the appeal was submitted, if applicableoptional	2023-03-15
`appeal_resolution_date`	date	Date when the appeal was resolved, if applicableoptional	2023-03-28
`last_updated`	datetime	Timestamp of the last update to the claim record	2023-01-22T14:34:15

Use it for

A healthcare dashboard
Recovered_amount by final_resolution_status and a breakdown of denial_reason_code. Excel, Power BI or Tableau.
Why do the 25 paid rows have a mean recovered_amount of 1,462?
A root-cause class exercise
Hand out the rows and one question. The answer is in the data, not in the brief.
Claims100
CLM100010unpaid
CLM100020written …
CLM100031439.99paid
A software demo
Believable claims with patient_id, provider_id and payer_id to fill a screen in front of a buyer.

This dataset100 rows19 columns

Yours10,000 rows19 columns

blueprint · claims-denials-and-rejection-management

Behind this dataset

Same schema. As many rows as you need.

These 100 rows came out of a blueprint — 19 columns with generation rules behind each one. Open it in Data Factory to retune a column, add your own, wire in foreign keys, and run it at the size you actually need.

Rules it was built with

Denial ID unique per denial event
Denial type: hard denial (not paid), soft denial (correctable)
Denial reason: medical necessity, authorization, timely filing, duplicate, coding error
CARC (Claim Adjustment Reason Code) from payer
Denial date and aging
Preventable vs non-preventable denials
Denial category: clinical, administrative, technical
Root cause analysis: missing auth, wrong code, expired eligibility

Rows1,000 rows10,000 rows100,000 rows1,000,000 rows

Open the blueprint in Data Factory

1 credit per row. New accounts start with 25 free credits.

Exports: CSV, JSON, JSONL, Parquet, SQL, Excel, TSV, XML
Licence: yours to use, including commercially
API slug: claims-denials-and-rejection-management

What should your data show?

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Sample rows

What the 100 rows show

Columns

Use it for

A healthcare dashboard

A root-cause class exercise

A software demo

Make it yours.

Same schema. As many rows as you need.

More in Healthcare

What should your data show?