The denials that turn on the chart, not the medicine.

Biologic denials for Crohn's and colitis turn on step therapy and reauthorization.

Biologic denials hinge on the DMARD trail and a disease-activity score.

Drug-compendia and radiation-technique denials — and a high overturn rate when filed.

“Cosmetic” reclassifications and biologic step-therapy — both answerable.

Joint-replacement and fusion denials turn on the documented conservative-care pathway.

Migraine biologics, Botox, and infusions turn on step therapy and protocol criteria.

Injection and ablation denials turn on the conservative-care trail and frequency limits.

Sleep-study and PAP denials turn on test setting and documented adherence.

Advanced imaging, devices, and PCSK9 step-therapy denials turn on the criteria trail.

Severe-asthma biologics and IVIG denials turn on step therapy and diagnostic criteria.

Minimally invasive BPH procedures turn on an “investigational” label and the therapy trail.

Balloon sinuplasty and functional-vs-cosmetic denials turn on documented medical necessity.

Diabetes drugs, osteoporosis biologics, and devices turn on step therapy and PA criteria.

Anti-VEGF step therapy is the appealable core; much of the rest is coding.

Severe-asthma biologics and home-oxygen denials turn on biomarkers and LCD criteria.

Level-of-care and parity denials are strongly appealable — the federal parity law is the lever.