Denial management is essential for healthcare providers to ensure timely and accurate reimbursement for their services, minimize revenue loss, and maintain positive relationships with payers. It requires attention to detail, a thorough understanding of payer policies, and proactive efforts to address and prevent denials.
Get started
Turn on denial management
Click Utilities.
Click Preferences then Company Preferences.
Scroll down to Enable Denial Management and select Yes from the dropdown menu.
Click Save.
Please log off and log back in so the preferences take effect.
Access denial management
Click Utilities.
Click Practice Setup then Denial Management.
You will need to set up these three tabs before using the denial management feature:
- Denial Status
- Denial Types
- Appeal Letter Templates Denial Status
Denial status
Enter the desired name of the new status, along with a description explaining the status. Once you have the status created, click Save.
Denial types
The Denial Types tab allows you to customize the type of denials associated with a claim and even create a group denial type with multiple codes. For example, if the claim was denied for missing patient information, you could create a group denial type called “Patient Information Missing” to help you categorize your denials. The 277 denial codes are pulled directly from CMS. To add a new denial type, click on the New Denial Type in the top right-hand corner of your screen, as shown below.
Enter the desired name for your denial type and description. Then select the corresponding code numbers you would like to be associated with your new denial type by checking off each. Once you have the denial type created, click the Save button.
Appeal letter templates
The Appeal Letter Templates tab allows clients to customize appeal letters for denials. These templates can easily be personalized to pre-populate:
-
- Date
- Service Date
- Patient’s Name
- Provider
- Billing Payer
- Policy Number
To add a new appeal letter template, click on the New Appeal Letter Template in the top right-hand corner of your screen, as shown below:
Enter the desired Name of your appeal letter and a Description. On the left-hand side of the screen is where you add the personalization placeholders that will pre-populate information from the claim. Once your new appeal letter template is created, click the Save button.
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