Overview
Purpose
This report summarizes the configuration rules for Denial Codes.
Category
System
Type
Detail
Mode
Not applicable
Output Options
CSV or Excel
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. |
| Active | The current status of the adjustment and denial rule. Options include: All, Active, Inactive. |
| Group Code | The 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. |
| Practice | The practice for which the denial code is associated. |
| Payer | The payer to which the denial code is associated. |
| Plan | The plan to which the denial code is associated. |
| Excluded from Denial Code Reports | The 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'. |
| Level | List Selection | No | Filters by the categorization of the denial code. By default, this filter is set to All. Options include:
If the System option is selected for Level, all records will be returned. Selecting an additional option (Practice, Payer, Plan) in combination with System results in no records being returned. |
| Active | Drop Down | No | 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 Group | List Selection | No | Filters the list of denial codes by group assignment. By default, this filter is set to All. |
| Practices | List Selection | No | Filters by all practices or by one or more practices. By default, this filter is set to All. |
| Payers | List Selection | No | Filters by payer to which the claims were submitted. By default, this filter is set to All. |
| Plans | List Selection | No | Filters by plan to which claims were submitted. By default, this filter is set to All. |
| Report Folder | Drop Down | Yes | Designates where to place or save the output from the executed report. |