Complete this task to:
The fields available for update vary depending on whether you are updating a user created denial code or a default denial code.
Modifying User Created 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. 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. |
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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. |
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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 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. |
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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. |
Modifying System 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. Update the relevant information via the applicable steps below... | ||
3 | Verify that Inactive checkbox is not selected if the denial code is active. |
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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. | ||
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. |
Not applicable for this topic |