Creating Denial Management Rules

Use this task to add a user adjustment and denial rule specific to a practice, payer, or plan for the group and reason codes used in Connect Back Office.

Rules can be set for primary payments (via Primary tab) and non-primary payments (via Non-Primary tab).

Non-primary rules are created as a modification to a primary rule, and only after the primary rule has been created and saved. For steps on creating a non-primary rule, see the Updating Denial Management Rules topic.

Step-By-Step Guide

Primary Tab

Step	Instructions	Additional Information
1	From the Denial Management / Denial Codes tab, click Create (or press Alt + C). The Denial Code: New page opens.
2	Enter the 1 to 10-character code that identifies the denial management rule in the Code field.
3	Enter the description for this denial code in the Description field.
4	(Optional) Enter the text to appear on the statement when this denial code is used in payment entry in the Statement Label field.
5	Open the Adjustment drop down and select the applicable option to specify whether an adjustment is allowed for this adjustment and denial code.	By default, the Adjustment option is set to Allowed.
6	Open the Writeoff drop down and select the applicable option to specify whether a contractual writeoff is allowed for this adjustment and denial code.	By default, the Writeoff option is set to Allowed.
7	Open the Roll To drop down list and select the applicable rule for rolling financial responsibility at the insurance payment.	Options include: Next Plan, Guarantor, and Do Nothing.
8	(Optional) Open the Denial Code Group drop down and select the denial code group with which the code is associated.
9	(Optional) Select the Exclude from Denial Code Reports checkbox if the denial code should be excluded from denial code reports.
10	Click Add in the Group / Reason Codes section. The Add Group/Reason Code window opens.
11	Open the Group Code drop down list and select a group code for the denial rule categorization.
12	Open the Reason Codes drop down list and select a reason code for the denial rule categorization.
13	Click Save to save the adjustment and denial rule and close the Add Group/Reason Code window. The adjustment and denial rule is now listed on the Denial Management page.	If you have additional group and reason codes to add, click Save & Add Next. Select a group and reason code from the table, and then click Delete to remove it from the adjustment and denial rule.
14	Open the Denial Code Level drop down list and select the appropriate option for the adjustment and denial rule being created: Practice Payer Plan
15	Select the practice(s), payer(s), and plan(s) to which the rule is being associated.	The Practice, Payer, and/or Plan options will be available based on the selection made for the Denial Code Level.
16	Click Apply.
17	Click Save to save and close the page.