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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 | ||||||
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1 | From the Denial Managementpage/Denial Codes tab, select the denial code to be modified. |
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2 | Click Update (or press Alt + U). The Denial Code window Code: ID page opens. Update the relevant information via the applicable steps below... | Image Removed | ||||||
3 | Select the applicable Denial Code Level option: Practice specific, Payer specific, or Plan specific. | 4 | Open the Practice, Payer, or Plan drop down list and select the appropriate option based on the selected Denial Code Level option:
| 5 | 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 | 6 | Enter the description for this denial code in the Name field. |
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5 | Open the Roll To drop down list and select the applicable rule for rolling financial responsibility at the insurance paymentEnter 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. | |||||||
11 | Verify that Yes is selected for the Active field, indicating that this denial code is active. |
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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. |
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12 | Click Add in the Group / Reason Codes section. The Add Group/Reason Code window opens. | |||||||
13 | Open the Group Code | 12 | Open the Group drop down list and select a group code for the denial rule categorization. | 13 | ||||
14 | Open the the Reason Codes Codes drop down list and select a reason code for the denial rule categorization. | |||||||
14 | Click Add. The applicable group and reason codes are associated with this denial code. | |||||||
15 | Repeat Steps 12-14 to add associate additional group and reason codes with this denial code. | |||||||
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. |
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16 | Open the Denial Code Level drop down list and select the appropriate option for the adjustment and denial rule being created:
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17 | Select the practice(s), payer(s), and plan(s) to which the rule is being associated. |
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18 | Click Apply. | |||||||
19 | Click Save to save and close the page. | 16 | Click OK (or press Alt + O) to save the denial code and close the Denial Code window. The updated denial code is now listed on the Denial Management page. |
Modifying System Adjustment and Denial Rule
Step | Instructions | Additional Information | ||
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1 | From the Denial Managementpage/Denial Codes tab, select the denial code to be modified. |
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2 | Click Update (or press Alt + U). The Denial Code window Code: ID page opens. Update the relevant information via the applicable steps below... | Image Removed | ||
3 | Verify that Inactive checkbox is not selected if the denial code is active | 7 | Open the Roll To drop down list and select the applicable rule for rolling financial responsibility at the insurance payment. |
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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. | |||
11 | Verify that Yes is selected for the Active field, indicating that this denial code is active. |
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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. |
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10 | Click Apply. | |||
11 | Click Save to save and close the page. |
Creating Non-Primary Adjustment and Denial Rule
Step | Instructions | Additional Information | ||
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1 | From the Denial Management/Denial Codes tab, select the denial code to be modified. |
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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... |
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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. | 16 | Click OK (or press Alt + O) to save the denial code and close the Denial Code window. The updated denial code is now listed on the Denial Management page. |
Panel | ||||||
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Denial Management / Denial Codes Tab Denial Management / Denial Code Groups Tab |
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Not applicable for this topic |
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