Healthcare
26 columns
200 rows
8 formats

Finance-Healthcare Payment Denial Records

This dataset provides a comprehensive view of healthcare insurance payment denials, integrating financial, clinical, and administrative details for each denial event. It enables in-depth analysis of denial causes, patterns, and outcomes, supporting process optimization, revenue cycle management, and predictive denial analytics for healthcare providers and insurers.

opened 5 times
last updated 29 Jul 2025
by GoMask

The brief that made it

Denial root cause analysis and process improvement

Sample rows

preview · 8 of 200 rows · all 26 columns

denial_idstring	appeal_outcomestring	claim_amountfloat	appeal_submittedboolean	payer_namestring	claim_idstring	patient_idstring	provider_idstring	payer_idstring	service_datedate	claim_submission_datedate	denial_datedate	denied_amountfloat	allowed_amountfloat	denial_reason_codestring	service_codestring	diagnosis_codestring	claim_statusstring	appeal_datedate	patient_ageinteger	patient_genderstring	provider_specialtystring	provider_namestring	service_locationstring	denial_reason_descriptionstring	notesstring
DEN001	N/A	342.75	false	WellCare Partners	CLM1001	PAT001	PRV001	PAY01	2023-01-12	2023-01-18	2023-01-22	342.75	0	CO-16	99213	J30.1	denied	blank	28	male	internal medicine	Green Valley Medical Group	outpatient	Claim lacks required information for processing.	Routine checkup was denied due to missing documentation.
DEN002	pending	1278.5	true	Blue Horizon Health	CLM1002	PAT002	PRV002	PAY02	2023-02-05	2023-02-09	2023-02-15	1278.5	0	CO-50	93000	I10	denied	2023-03-04	66	female	cardiology	Atlantic Cardiac Specialists	outpatient	Service not deemed medically necessary by payer.	Cardiac evaluation was denied for lack of medical necessity. Appeal submitted.
DEN003	N/A	95	false	Unity Insurance	CLM1003	PAT003	PRV003	PAY03	2023-01-21	2023-01-25	2023-02-04	95	0	CO-197	90471	Z23	denied	blank	34	female	family medicine	Hillside Family Practice	urgent care	Precertification or authorization absent.	Immunization claim denied due to missing authorization.
DEN004	N/A	18455.6	false	Silverline Medicare	CLM1004	PAT004	PRV004	PAY04	2023-03-10	2023-03-13	2023-03-21	0	18455.6	CO-119	99285	C50.9	paid	blank	78	female	oncology	Mountain Oncology Center	inpatient	Benefit maximum for this time period has been reached.	Claim for chemotherapy treatment was paid in full.
DEN005	overturned	10	true	PrimeLife Health	CLM1005	PAT005	PRV005	PAY05	2023-01-07	2023-01-09	2023-01-17	10	0	CO-11	81000	Z00.00	denied	2023-02-04	0	other	emergency medicine	Sunrise Emergency Center	ER	Diagnosis inconsistent with procedure.	Newborn screening denied for code mismatch; appeal successful.
DEN006	N/A	1155.25	false	WellCare Partners	CLM1006	PAT006	PRV006	PAY01	2023-02-18	2023-02-25	2023-03-04	0	1155.25	CO-45	80053	E11.9	paid	blank	52	female	laboratory	Ridgeview Diagnostic Lab	clinical lab	Charge exceeds fee schedule/maximum allowable.	Lab panel paid as per allowable fee schedule.
DEN007	N/A	2750	false	Liberty Mutual Health	CLM1007	PAT007	PRV007	PAY06	2023-03-02	2023-03-05	2023-03-10	2750	0	CO-42	66984	H25.9	denied	blank	82	female	ophthalmology	Sunrise Eye Associates	specialty clinic	Charges exceed our fee schedule or maximum allowable amount.	Cataract surgery denied due to exceeding maximum allowable.
DEN008	N/A	850	false	Remedy Health Plan	CLM1008	PAT008	PRV008	PAY07	2023-04-16	2023-04-18	2023-04-28	0	850	CO-24	90834	F41.1	paid	blank	39	male	mental health	Bright Horizons Clinic	outpatient	Charges are covered under a capitation agreement/managed care plan.	Mental health counseling paid under managed care plan.
DEN009	overturned	10500	true	Silverline Medicare	CLM1009	PAT009	PRV009	PAY08	2023-02-22	2023-02-28	2023-03-07	0	10500	CO-54	36415	M05.79	overturned	2023-04-01	73	male	rheumatology	Blue River Rheumatology	inpatient	Multiple physicians/assistants billed for same service.	Claim for rheumatoid arthritis infusion overturned on appeal.
DEN010	N/A	95	false	Family Health Co.	CLM1010	PAT010	PRV010	PAY09	2023-03-11	2023-03-12	2023-03-16	95	0	CO-151	99392	Z00.129	denied	blank	25	female	pediatrics	Willow Pediatrics	outpatient	Payment adjusted because the payer deems information submitted does not support this level of service.	Well-child visit denied for lack of supporting documentation.
DEN011	N/A	72	false	WellCare Partners	CLM1011	PAT011	PRV001	PAY01	2023-01-17	2023-01-21	2023-01-27	0	72	CO-16	99214	R05	paid	blank	30	male	internal medicine	Green Valley Medical Group	outpatient	Claim lacks required information for processing.	Office visit for cough, claim processed and paid.
DEN012	overturned	14500	true	Apex Health Insurance	CLM1012	PAT012	PRV011	PAY10	2023-02-03	2023-02-07	2023-02-20	0	14500	CO-97	96413	C00.9	overturned	2023-03-23	54	female	oncology	Central Oncology Center	specialty clinic	Payment is included in the allowance for another service/procedure.	Cancer infusion claim was overturned after appeal.
DEN013	upheld	120	true	Blue Horizon Health	CLM1013	PAT013	PRV012	PAY02	2023-04-01	2023-04-05	2023-04-13	120	0	CO-29	99282	R07.9	denied	2023-05-02	74	female	geriatrics	Golden Age Geriatric Center	outpatient	The time limit for filing has expired.	Late claim for chest pain denied; appeal was not successful.
DEN014	pending	670	true	Unity Insurance	CLM1014	PAT014	PRV013	PAY03	2023-03-19	2023-03-20	2023-03-25	402	268	CO-144	80061	Z13.6	appealed	2023-04-14	47	female	preventive care	Community Preventive Health	outpatient	Incentive adjustment; not covered under the plan.	Lipid panel partial denial; appeal in process.
DEN015	N/A	860	false	Liberty Mutual Health	CLM1015	PAT015	PRV014	PAY04	2023-01-28	2023-02-01	2023-02-12	0	860	CO-204	99291	F10.20	paid	blank	43	male	addiction medicine	Northside Recovery Center	specialty clinic	This service is not covered under the patient’s current benefit plan.	Detoxification services paid under benefit plan.
DEN016	N/A	99	false	PrimeLife Health	CLM1016	PAT016	PRV015	PAY05	2023-02-15	2023-02-19	2023-02-27	99	0	CO-18	99239	Z76.89	denied	blank	57	female	radiology	Imaging Center South	outpatient	Duplicate claim/service.	Radiology claim denied as duplicate entry.
DEN017	overturned	22800	true	Liberty Mutual Health	CLM1017	PAT017	PRV016	PAY06	2023-03-05	2023-03-09	2023-03-14	0	22800	CO-151	99284	C43.9	overturned	2023-04-03	61	male	dermatology	Dermacare Specialists	inpatient	Payment adjusted due to insufficient documentation.	High-cost skin cancer procedure initially denied, later overturned.
DEN018	N/A	1100	false	Remedy Health Plan	CLM1018	PAT018	PRV017	PAY07	2023-04-10	2023-04-14	2023-04-21	0	1100	CO-45	80048	Z13.6	paid	blank	40	female	laboratory	Bright Horizons Clinic	clinical lab	Charge exceeds maximum allowable but paid per policy.	Comprehensive metabolic panel paid as per plan.
DEN019	N/A	0.01	false	Silverline Medicare	CLM1019	PAT019	PRV018	PAY08	2023-04-19	2023-04-22	2023-04-29	0.01	0	CO-197	81001	R80.3	denied	blank	105	unknown	multi-specialty	Sunrise Emergency Center	clinical lab	Authorization missing for submitted claim.	Extremely low claim denied for missing authorization.
DEN020	overturned	15000	true	Family Health Co.	CLM1020	PAT020	PRV019	PAY09	2023-03-25	2023-03-29	2023-04-06	0	15000	CO-204	99292	S06.0X0A	overturned	2023-05-01	57	male	surgery	Summit Surgical Group	inpatient	Service not covered under plan, but exception granted.	Post-trauma surgery claim overturned after review.

What the 200 rows show

from the 200-row sample

Pending (appeal outcome) stands out: 34 of its 34 rows have appeal_submitted = true, against 41 of 166 for the rest.

38%appeal_submitted = true
467.6median claim_amount
4claim statuses
4patient genders
6service locations
15denial reason codes

Appeal submitted rate by appeal_outcomeappeal_submitted = true

claim_amount200 rows, in bands of 20k

Median 467.6, from 0.01 to 120,000.

payer_name200 rows · top 10 of 33 values

Blue Horizon Health15
Blue Ridge Health10
Midsouth Mutual10
Sunrise Healthcare10
Summit Assurance10
Liberty Mutual Health9
WellCare Partners6
Silverline Medicare6
Unity Insurance5
PrimeLife Health5

26 columns by typefrom the column list below

string 17
integer 1
float 3
date 4
boolean 1

Columns

26 columns in four groups

blueprint · 26 columns
column	type	description	example
Text 17 columns
`denial_id`	string	Unique identifier for each payment denial recordunique	DEN001
`claim_id`	string	Unique identifier for the associated insurance claim	CLM1001
`patient_id`	string	Unique identifier for the patient associated with the claim	PAT001
`provider_id`	string	Unique identifier for the healthcare provider submitting the claim	PRV001
`payer_id`	string	Unique identifier for the insurance payer/plan	PAY01
`denial_reason_code`	string	Standardized code indicating the reason for denial (e.g., ANSI, CARC)	CO-16
`denial_reason_description`	string	Human-readable description of the denial reason	Duplicate claim/service.
`service_code`	string	Code representing the medical service or procedure (e.g., CPT, HCPCS)	99213
`diagnosis_code`	string	Primary diagnosis code associated with the claim (e.g., ICD-10)	J30.1
`claim_status`	string	Current status of the claim (e.g., denied, appealed, overturned, paid)denied · appealed · overturned · paid	denied
`appeal_outcome`	string	Outcome of the appeal, if submitted (e.g., upheld, overturned, pending, N/A)upheld · overturned · pending · N/A · optional	N/A
`patient_gender`	string	Gender of the patientmale · female · other · unknown · optional	male
`provider_specialty`	string	Medical specialty of the provider (e.g., cardiology, orthopedics)optional	internal medicine
`payer_name`	string	Name of the insurance payer/planoptional	WellCare Partners
`provider_name`	string	Name of the healthcare provider or facilityoptional	Hillside Family Practice
`service_location`	string	Location where the service was provided (e.g., inpatient, outpatient, ER)6 locations · optional	outpatient
`notes`	string	Additional notes or comments related to the denialoptional	Routine checkup was denie…
Numbers 4 columns
`claim_amount`	float	Total amount billed in the claim0 or more	342.75
`denied_amount`	float	Amount denied by the payer0 or more	342.75
`allowed_amount`	float	Amount allowed by the payer (if any)0 or more · optional	0
`patient_age`	integer	Age of the patient at the time of service0 to 120 · optional	28
Dates and times 4 columns
`service_date`	date	Date on which the medical service was provided	2023-01-12
`claim_submission_date`	date	Date when the claim was submitted to the payer	2023-01-18
`denial_date`	date	Date when the payment denial was issued	2023-01-22
`appeal_date`	date	Date when the appeal was submitted (if applicable)optional	2023-03-04
True or false 1 column
`appeal_submitted`	boolean	Indicates whether an appeal was submitted for the denial	false

Use it for

A healthcare dashboard
The appeal_submitted rate, claim_amount by appeal_outcome and a breakdown of payer_name. Excel, Power BI or Tableau.
Why do 75 of 200 rows have appeal_submitted = true?
A root-cause class exercise
Hand out the rows and one question. The answer is in the data, not in the brief.
Denials200
DEN001342.75N/A
DEN0021278.5pending
DEN00510overturn…
A software demo
Believable denials with claim_id, patient_id and provider_id to fill a screen in front of a buyer.

This dataset200 rows26 columns

Yours1,000 rows26 columnsservice_location: UK only

blueprint · finance-healthcare-payment-denial-records

Behind this dataset

Same schema. As many rows as you need.

These 200 rows came out of a blueprint — 26 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

Each record links a payment and claim ID
Denial types categorized by code
Medical procedures matched to policy rules
Reversals and appeals tracked

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

Open the blueprint in Data Factory

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Exports: CSV, JSON, JSONL, Parquet, SQL, Excel, TSV, XML
Licence: yours to use, including commercially
API slug: finance-healthcare-payment-denial-records

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Sample rows

What the 200 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.

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