Understanding Denials
A denial is when the payer does not intend to pay for the service or product provided. A denial is returned once a payer has accepted a claim but returned a remittance with either no payment or only a partial payment.
Once a denial is received on a claim you can;
Write off the charge
Appeal the decision with the insurance
Resubmit the claim to be reopened with additional information
Common Denials
Expired or missing prior authorizations
The quantity of items supplied exceeds the insurance frequency allowable
Incorrect or missing modifiers
Inconsistent diagnosis codes with products or services supplied
Terminated or inactive insurance coverage
How to locate denials
When a denial transaction is posted against an invoice also known as your "claim"
The invoice status will automatically update to "denied"
A denial label will appear on the service line of the invoice to indicate which services were denied.
The denial queue located under the Billing/Denials page will show the service line denial.
A denials detail report is available under reports.