This page highlights all the details in a claim that is in Denial stage.
Encounter ID
The encounter identifier used to link medical records, claims, and billing activity for a single visit.
Status
This status reflects the case’s progress within the current billing stage only (e.g. EOB Posting). It applies to the task assigned to the selected assignee in this tab.
When the assignee completes the task, the case will be marked complete for this stage, but this does not mean the entire claim has been fully processed.
Key Actions
Use these actions to manage the claim:
Defer
Defer the case to be worked on at a later time.
Print
Print the CMS-1500 form.
Message
Send a message about this specific encounter to a member of your team.
Assign
Assign this case to someone on the team
Remove
Remove the claim from the current queue.
Patient Information
This section highlights key patient information, including the patient’s name, Billing Account ID, EHR ID, primary and secondary payers, provider, date of service, the assignee currently responsible for the case, and order of benefit.
Service/Claim/Notes
This side tab provides additional context and detailed information to help you better understand and manage the case.
Service
View service-related details such as surgeries performed, physician notes, clinical documentation from the EHR, operative notes, hospital consult notes, other chart notes, the facility code and name, and the hospital admission date.
Claim
Review key claim information and actions, including submission dates, submission method, and other claim-related details.
Notes
Add notes about the case and document actions taken to keep your team aligned and informed.
Denial Message
This red banner indicates that the claim has been denied and requires additional review and action, including submitting an appeal if necessary.
Charges
This section highlights the total charges that were billed to the payer. It also displays the procedure codes and modifiers associated with the encounter, along with the corresponding units and diagnosis codes.
Payment Summary
This section breaks down charges at the procedure level to help you understand how each service was billed and paid. For each procedure code, you can see the number of units billed, the payer responsible, the original charge, the allowed amount, any adjustments, amounts paid by insurance and the patient, the write-off, and the remaining balance.
EOB
This section displays the EOB returned by the payer along with the associated denial codes. It also provides descriptions for each denial code.
EOB for Inactive Payer
Displays any EOBs linked to inactive payers.
Appeal Letter Tracker
If an appeal letter is sent, you can add the delivery method and the content of the appeal letter in this section.
Approve
After the appropriate actions are taken to handle the denial, e.g. a write-off or an appeal, click Approve to acknowledge the denial.