What's in this Release?
This release includes a bug fix that will improve the PM experience for billing customers, and additional troubleshooting data for customers sending claims to TriZetto.
Resolved Denial Data Mismatch
What’s being addressed?
We fixed a bug where there was a mismatch between the total count of denied claims in Kareo PM versus the daily KPI report and Reports Dashboard. When a denied claim was reopened and a new follow-up date was set, the claim status changed to Pending Insurance and moved out of the denial queue, but the claim would still be counted as denied in KPI reports and the Reports Dashboard.
Why are we addressing this?
To help billers view accurate data across the application.
How are we addressing?
With this fix, billers will be able to see the same denied claims throughout the application, including the dashboard and daily KPI reports, helping billers work efficiently and eliminate confusion and errors while completing their daily work items.
Here is an example of the process working correctly.
|Denials category with a count of 51 denied claims.|
|A denied claim is opened and given a follow-up date. The claim moves out of the denial queue and has a status of Pending Insurance.|
|Denials category with an updated count of 50 denied claims.|
|Reports Dashboard with the correct count of 50 denied claims.|
|Daily KPI Report will have the correct count of 50 denied claims. Report available here:|
Description for TriZetto (formerly Gateway) Adjustment/Denial Code Reasons and Remarks
Recently the adjustment/denial code reasons and remarks from TriZetto contained obscure, unhelpful codes such as "CO-45". Kareo saw a need to enhance our electronic remittance advice (ERA) report to include the adjustment/denial code reasons and remarks with an accompanying, easier to understand reason description. See below for an example of new reason descriptions.
|Below the service line item table, a second table defines each reason description for the adjustment/denial code reasons and remarks in the order received.|