Updating Denial Management Rules

Complete this task to:

Modify a user denial code for a practice, payer, or plan
Modify the statement label
Modify the status of a default denial code
Create a non-primary version of a primary adjustment and denial rule

The fields available for update vary depending on whether you are updating a user created denial code or a default denial code.

Step-By-Step Guide

Modifying User Created Adjustment and Denial Rule

Step	Instructions	Additional Information
1	From the Denial Management/Denial Codes tab, select the denial code to be modified.	User Filter option at the top of the page to limit codes to Practice, Payer, or Plan codes.
2	Click Update (or press Alt + U). The Denial Code: ID page opens. Update the relevant information via the applicable steps below...
3	Enter the 1 to 10-character code that identifies the denial management rule in the Code field.
4	Verify that Inactive checkbox is not selected if the denial code is active.
5	Enter the description for this denial code in the Description field.
6	(Optional) Enter the text to appear on the statement when this denial code is used in payment entry in the Statement Label field.
7	Select the applicable Adjustment option to specify whether an adjustment is allowed for this denial code.
8	Select the applicable Writeoff option to specify whether a contractual writeoff is allowed for this denial code.
9	Open the Roll To drop down list and select the applicable rule for rolling financial responsibility at the insurance payment.
10	(Optional) Open the Denial Code Group drop down and select the denial code group with which the code is associated.
11	(Optional) Select/deselect the Exclude from Denial Code Reports checkbox.	If the checkbox is selected, the denial code is excluded from denial code reports.
12	Click Add in the Group / Reason Codes section. The Add Group/Reason Code window opens.
13	Open the Group Code drop down list and select a group code for the denial rule categorization.
14	Open the Reason Codes drop down list and select a reason code for the denial rule categorization.
15	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.
16	Open the Denial Code Level drop down list and select the appropriate option for the adjustment and denial rule being created: Practice Payer Plan
17	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.
18	Click Apply.
19	Click Save to save and close the page.

Modifying System Adjustment and Denial Rule

Step	Instructions	Additional Information
1	From the Denial Management/Denial Codes tab, select the denial code to be modified.	User Filter option at the top of the page to limit codes to Practice, Payer, or Plan codes.
2	Click Update (or press Alt + U). The Denial Code: ID page opens. Update the relevant information via the applicable steps below...
3	Verify that Inactive checkbox is not selected if the denial code is active.
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	Select the applicable Adjustment option to specify whether an adjustment is allowed for this denial code.
6	Select the applicable Writeoff option to specify whether a contractual writeoff is allowed for this denial code.
7	Open the Roll To drop down list and select the applicable rule for rolling financial responsibility at the insurance payment.
8	(Optional) Open the Denial Code Group drop down and select the denial code group with which the code is associated.
9	(Optional) Select/deselect the Exclude from Denial Code Reports checkbox.	If the checkbox is selected, the denial code is excluded from denial code reports.
10	Click Apply.
11	Click Save to save and close the page.

Creating Non-Primary Adjustment and Denial Rule

Step	Instructions	Additional Information
1	From the Denial Management/Denial Codes tab, select the denial code to be modified.	User Filter option at the top of the page to limit codes to Practice, Payer, or Plan codes.
2	Click Update (or press Alt + U). The Denial Code: ID page opens.
3	Click the Non-Primary tab. Update the relevant information via the applicable steps below...	The Non-Primary tab will be a duplicate of the Primary tab values. Editable items can be modified as needed for the non-primary adjustment and denial rule.
4	Enter the description for this denial code in the Description field.
5	(Optional) Enter the text to appear on the statement when this denial code is used in payment entry in the Statement Label field.
6	Select the applicable Adjustment option to specify whether an adjustment is allowed for this denial code.
7	Open the Roll To drop down list and select the applicable rule for rolling financial responsibility at the insurance payment.
8	Click Apply.
9	Click Save to save and close the page.