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Working Denied claims – this should be done on a daily basis
DENIED CLAIM – CLAIM THAT WAS SENT TO AND ACCEPTED BY THE CARRIER INTO THE CLAIMS ADJUDICATION SYSTEM. HOWEVER, THE CLAIM WAS DENIED AND NO PAYMENT WAS ISSUED.
1. To find these claims, from Claims Manager, with correct customer ID chosen, click on the CLAIM STATUS field, using the drop down arrow to the right of it.
2. The Status Selection window opens. If all choices have an X in the left column, click the CLEAR button to remove all the X’s. Then click on the DENIED status only.
3. Click the SAVE icon (floppy disk icon) in the right corner. This will bring the DENIED status back to the claim status in the prior window. Click on SELECT CLAIMS button.
4. This will present a list of claims in the middle window that have been denied by the carrier. By single clicking on a claim, the lower window will present a line with ERA under the Source column and a message AMOUNT PAID =$0
5. By right clicking on the ERA line in the lower window, you can then click on VIEW EOB STANDARD REMITTANCE. This will open the EOB where the denial reason will be found. It will also only show you this specific patient, even though this denial may have come through on an ERA file or check that showed 50 patients. Keep this in mind if you ever need to print the EOB for an individual patient, or individual claim for any other purpose.
6. In much the same way that an invalid or rejected claim can be fixed in PI, denied claims can be edited and fixed. You can then click READY FILE to send it back out to the carrier.