DEN-2024-00123
Denied by Johnson & Johnson - Customer not eligible
Vendor's Denial Report
- Denial Reason Code
- CUST_NOT_ELIG
- Denial Reason
- Customer not on contract during claim period
- Denied Amount
- $12,450.00
- Transaction Count
- 45 transactions
- Vendor Reference
- MFR-DEN-2024-12345
- Received Date
- Nov 10, 2024
Original Claim Summary
- Claim ID
- CLM-2024-78901
- Contract
- CTR-2024-0089
- Claim Period
- October 2024
- Submitted Date
- Nov 5, 2024
- Total Transactions
- 156
- Claim Amount
- $18,450.00
Root Cause Analysis
Timing Issue Detected
Customer ABC Hospital was added to the contract on November 1, 2024. However, the denied transactions occurred between October 15-31, 2024, before the customer was officially added to the contract.
Suggested Action: Verify if contract amendment exists with retroactive effective date.
Data Lineage Trace
Source
E1 Sales
Contract
CTR-0089
Optimization
RUN-1101
Claim
CLM-78901
Submitted
Nov 5
Denied
Nov 10
Data Comparison: Our Records vs Vendor
| Data Point | Our Record | Mfr Record | Match |
|---|---|---|---|
| Customer ID | CUST-001 | HIN-12345 | Match |
| Customer Effective Date | Jan 1, 2024 | Nov 1, 2024 | Mismatch |
| Item | SKU-JNJ-001 | MFR-ABC | Match |
| Contract Price | $12.50 | $12.50 | Match |
| Claim Period | Oct 2024 | Oct 2024 | Match |
Evidence for Dispute
Contract Amendment
RequiredProof that customer was added retroactively
Customer Membership Proof
RequiredGPO membership documentation for customer
Sales Invoices
Attached (45)Original sales invoices for denied transactions
Email Correspondence
OptionalAny relevant email communication with vendor
Substantiation Notes
Manager Approval Required
Amount exceeds $10,000 threshold
45 transactions denied
| Invoice | Date | Customer | Item | Amount | Denial Reason | Action |
|---|---|---|---|---|---|---|
| INV-2024-12345 | 10/15/2024 | ABC Hospital | SKU-JNJ-001 | $325.00 | Customer not eligible | |
| INV-2024-12346 | 10/16/2024 | ABC Hospital | SKU-JNJ-002 | $189.00 | Customer not eligible | |
| INV-2024-12347 | 10/18/2024 | ABC Hospital | SKU-JNJ-001 | $450.00 | Customer not eligible |
Resolution History
Denial Received
Nov 10, 2024 08:00 AMImported from EDI 849 - MFR-DEN-2024-12345
System
Assigned to Analyst
Nov 10, 2024 09:30 AMAssigned to Sarah Johnson based on vendor expertise
System - Auto-assignment
Research Started
Nov 11, 2024 10:00 AMInitiated data lineage research
Sarah Johnson
Root Cause Identified
Nov 12, 2024 02:30 PMCustomer effective date mismatch between our records and vendor's contract file
Sarah Johnson
Document Requested
Nov 12, 2024 03:00 PMRequested contract amendment from Contracts team
Sarah Johnson
Submit Dispute
2 required documents missing. Please upload before submitting.
45 invoices attached
Accept Denial
Accepting this denial will write-off $12,450.00. This action cannot be undone.