Denied Claim Simulator · for Primary Care
Denied Claim Training for Primary Care
Practice a deliberately narrow skill: diagnosing denial patterns in synthetic primary-care claims without turning the product into coding instruction. You will read the claim, flag the evidence, name the denial category, choose the next action, and see feedback on the reasoning behind each choice.
What is specific
Claims written for primary care, not swapped labels.
The curriculum is shared because its priority denial categories are shared across the four profession packages. The authored claims, practice settings, and worked details are profession-specific.
The narrowest scope
Primary care is the widest departure from the behavioral-health reference library, so this pack stays intentionally focused on denial diagnosis.
A priority denial library
Twenty practice scenarios cover every priority denial category, with a separate twelve-scenario pool held out for the final simulation exam.
No coding instruction
The scenarios use synthetic service codes to practise reading claims. They do not teach visit levels, code selection, real modifiers, or coding-exam material.
What the certificate means
Passing the final simulation exam earns a certificate of completion, not a professional credential. It is not a professional certification, license, or coding credential.
Profession-preselected demo
Work a denied primary-care claim
Start with a guided synthetic primary-care claim and diagnose why it denied. The exercise is about reading evidence and naming the denial pattern, not choosing codes.
The open scenario below comes from the primary care library. After the email gate, the two shared follow-up examples cover eligibility and prior authorization; only the open scenario changes with your profession.
- 1 Read
- 2 Flag
- 3 Decide
- 4 Learn
The primary-care pack teaches denial diagnosis, not medical coding. It does not teach code selection or prepare you for a coding credential.
Difficulty 1 · SIM-CLM-3014
The Home-Video Visit in the Office Lane
high-volume primary-care group running office and video clinics in parallel
Training scenario — all details are synthetic. Real-world rules vary by payer and change over time; verify before acting on anything you learn here.
The primary-care pack teaches denial diagnosis, not medical coding. It does not teach code selection or prepare you for a coding credential.
Content last reviewed: August 2026. Billing rules change — verify anything you act on against current official sources and your own payer documents.
The denial
Ironwood Benefit Group — Explanation of Benefits
SIM-D03
The location and telehealth fields describe different visit settings.
Evidence on the claimOpen
The claim as submitted
1 field is suspect · flag up to 3
0 of 3 fields flagged.
Patient
Coverage
Provider
Service & claim fields
Hints
Free in guided mode.
- The modality is documented and the required modifier is present. Find the field that still describes an office encounter.
- Compare placeOfService with the signed home-video record; the parallel clinic lanes explain how the office value arrived.
Flag at least one field to continue.
The full path
The demo is one claim. The skill is built by repetition.
Your profession package includes the shared learning system around its scenario library. The optional expanded-access upgrade changes tools and vault access, not the denial practice.
- Six learning modules and the lab's ten priority denial categories — a starting set, not a complete taxonomy.
- 20 profession-specific practice scenarios plus a held-out final exam pool.
- Guided Mode for first passes and Drill Mode for quick recognition reps.
- Feedback on evidence, category, next action, and correction steps.
- A Denial Prevention Playbook assembled from completed scenarios.
- A certificate of completion, not a professional credential.