If a payer denies a claim, you can account for it by posting a denial. Posting a denial will also help with reporting and audit trails.
To post a denial from an EOB
- Click Encounters>Receive Payment in the top menu.
- Enter the following information in the New Payment window. (View the payment posting article for additional details.)
- Batch #: (Optional)
- Post Date: Defaults to current date, or you can enter the date of your choice.
- Type: Set to Insurance
- Insurance: Click the Insurance button and select the insurance plan associated with the payment.
- Adjudication Date: Enter the date shown on the EOB that the claim was processed.
- Category: (Optional)
- Method: N/A due to payment amount being $0.00. Leave at default setting of 1 - Check.
- Reference #: Enter the check number shown on the EOB.
- Amount: Leave set to $0.00
Click Apply Now when finished.
4. On the Apply tab, select Add Encounter.
5. Enter the encounter number shown on the EOB and press Enter on your keyboard. (All numbers before the letter Z in the Claim ID.)
6. Select the service line that applies to the denial.
7. Click in the Allowed field and leave amount at $0.00.
8. Tab to the Contract Adj field. The charge amount will automatically fill.
9. Enter $0.00 in the Paid field.
10. Ensure the Status drop-down menu is set to Default.
11. Click +More in the lower-right corner of the window.
12. Select 7 - Note from the drop-down menu.
13. Enter remarks from the EOB to describe the reason(s) for the denial, and click Post when finished.
14. Choose one of the following to proceed:
- Click Next Line to move to the next service line in the encounter.
- Click Add Encounter to select another encounter from the EOB.
- Click Save & New to save the payment record and enter payment from a new EOB.
- Click Save if there are no additional encounters to be entered from the EOB.
To find and view a denied claim
- Click Encounters > Track Claim Status to open the Find Claims window.
- Select Denials from the drop-down menu in the top left of the window.
- Click Find Now in the upper right of the window.
- Find and double click on the claim to open the Edit Claim window.
- Scroll through the Transactions lines to find the denied claim.
- Hover over the denial summary to view a pop-up with the reason code, description, and any remarks.