What information should be included in a payer inquiry when a claim is denied?

• A. Member's social media profile.
• B. Future appointment preferences.
• C. Member details, claim number, service dates and codes, denial reason, and supporting documentation.
• D. Billing address only.

Answer: (C)

When a claim is denied, the payer needs enough detail to locate the exact claim, understand the reason for denial, and evaluate what’s needed to resolve it. The best answer includes all the key elements: member details, the claim number, service dates and codes, the denial reason, and any supporting documentation.

Member details identify the patient and ensure the inquiry is linked to the correct record. The claim number is the precise reference to the denied submission. Service dates and codes show what was billed and when, which helps verify eligibility and coverage rules. The denial reason explains why the claim was rejected, guiding what needs to be corrected or disputed. Supporting documentation (such as medical records, notes, authorization, or prior communication) provides evidence to support the claim or to clarify missing information.

The other options miss critical pieces or involve unrelated information. A member’s social media profile isn’t relevant for processing a denial and raises privacy concerns. Future appointment preferences don’t address the denial details. A billing address alone doesn’t supply the necessary identifiers or the denial explanation needed to resolve the issue.

Providing complete information accelerates locating the claim, understanding the denial, and supporting an effective resolution or appeal.