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Overview

Purpose

This report summarizes the configuration rules for Denial Codes.

Category

System

Type

Detail

Mode

Not applicable

Output Options

CSV or Excel

How to Get Here?

From Portal:
From Back Office:
  1. From the Reports tab, locate the Denial Code Configuration Detail report.
  2. Click Edit for the report.
  3. Enter/select filter criteria on the Criteria page.
  4. Click Run Report.
  1. Open the Manage menu and select Reports.
  2. From the Reports page > Modern tab, select the Denial Code Configuration Detail report from the list of reports.
  3. Click Run (or press [Alt] + [R]).
  4. Enter/select the filter criteria from the Parameters window.
  5. Click Run (or press [Alt] + [R]).

 

Sample Reports

(Click an image to enlarge)

Portal

Back Office 


Field Definitions

Field

Description

Code

The name, or up to 10 character code, of the adjustment and denial rule. System adjustment and denial rules have a prefix of RC.

Level

The categorization of the denial code. Options include: System, Practice, Payer, Plan. 

Description

The description of the adjustment and denial rule.

ActiveThe current status of the adjustment and denial rule. Options include: All, Active, Inactive.  
Group CodeThe name of the denial code grouping assigned to the adjustment and denial rule.
Roll To (Primary)The adjustment and denial rule for rolling primary financial responsibility to the next party. Options include: Do Nothing, Next Plan, Guarantor, Write Off Balance.
Adjustment (Primary)Specifies if a primary adjustment is allowed. Options include: Allowed, Disallowed.
Writeoff (Primary)Specifies if a primary contractual writeoff is allowed for the adjustment and denial rule. Options include: Allowed, Disallowed.
Roll To (Non-Primary)The adjustment and denial rule for rolling non-primary financial responsibility to the next party. Options include: Do Nothing, Next Plan, Guarantor, Write Off Balance.
Adjustment (Non-Primary)Specifies if a non-primary adjustment is allowed. Options include: Allowed, Disallowed.
Writeoff (Non-Primary)Specifies if a non-primary contractual writeoff is allowed for the adjustment and denial rule. Options include: Allowed, Disallowed.
PracticeThe practice for which the denial code is associated.
PayerThe payer to which the denial code is associated.
PlanThe plan to which the denial code is associated.
Excluded from Denial Code ReportsThe designation as to whether the denial code is included in Denial Code reports. Options include: Yes, No.

Available Report Filters

Option

Type

Required 

Description

Code

Drop Down

No

Filters by code. Note: System codes begin with a prefix of 'RC'. 

LevelList SelectionNo

Filters by the categorization of the denial code. By default, this filter is set to All. Options include: 

  • System - system rules, or common for all 
  • Practice - user-defined rules assigned to specific practice(s)
  • Payer - user-defined rules assigned to specific payer(s)
  • Plan - user-defined rules assigned to specific plan(s)
ActiveDrop DownNo

Filters by the current status of the adjustment and denial rules. Options include: Active, Inactive. By default, this filter is set to All.

Denial Code GroupList SelectionNo

Filters the list of denial codes by group assignment. By default, this filter is set to All.

Practices List SelectionNo

Filters by all practices or by one or more practices. By default, this filter is set to All.

Payers List SelectionNoFilters by payer to which the claims were submitted. By default, this filter is set to All.
Plans List SelectionNoFilters by plan to which claims were submitted. By default, this filter is set to All.
Report FolderDrop DownYesDesignates where to place or save the output from the executed report.


 

Related Topics

Portal

Reports (Portal)



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