RXNT’s denial management workflow streamlines the process of disputing denials. All ERAs are automatically scanned for denials and assigned a corresponding line item status. Based on the type of denial, certain adjustment amounts are removed while the remaining insurance balance stays intact. Denied claims are then moved to the denial queue, allowing your team to efficiently rework them and maximize reimbursement.
By default, Denial Management workflow is enabled for all companies.
View denials
To view ERA denials, click Pending ERAs.
Click the Payment Number you want to view in the Post Payment column.
Click on a patient's name in the Patients Linked section.
If the selected patient has payments for multiple dates of service, all associated encounters will be linked and displayed in the Encounters Linked section. Select the encounter date of service you want to view.
If a line item in an encounter contains a denial adjustment code, its status is automatically set to Accept & Rework Denial.
The adjustment amount for the corresponding denial is $0.00.
Click Save and Post to send the denial to Denial Management.
Denial management queue
The Denied/Left Open tab allows you to efficiently manage claims that have been denied by insurance companies. When claims are moved to this section, they are organized into either the Denied or Left Open sub-tab. You can easily search and filter through various columns to locate specific claims.
To access this section, click the Claims tab in the top navigation bar and select Denied/Left Open. This tab includes two sub-tabs, Denied and Left Open, where claims are categorized based on their denial status:
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Denied Tab: If a payment linked to a claim contains at least one line item marked as “Accept & Rework Denial” or “Rework Denial”, the claim and its associated encounter are moved to the Denied tab.
- Left Open Tab: If a payment linked to a claim contains at least one line item marked as “Awaiting Payment” or “Ignore Line Item”, the claim and its associated encounter are moved to the Left Open tab.
If a payment contains both a denial status and a non-denial status, the claim and encounter will default to the Denied tab.
The Show Only Current Denied Claims and Show Only Current Left Open Claims toggles appear under the Denied and Left Open tabs, respectively. These toggles are on by default, which means the system displays only encounters tied to active denials and left-open line items. These include claims associated with payments that have a status of Awaiting Payment and Ignore Line Item, as well as denials. This means encounters with a status of Sent to Payer – Leave Open.
For example, if a claim was previously and still has the status Sent to Payer – Leave Open, it will appear by default because it is considered an active denial.
When the toggle is turned off, encounters associated with historic (inactive) denials are also displayed in the tab. For example, if a claim was denied last year but has since been resolved, turning the toggle off will allow that historic denial to appear alongside current denied claims.
To send an appeal letter to the payer, click the printer icon in the Appeal Template column. You’ll be prompted to choose one of your pre-made templates. After selecting the desired template, click Generate to print the letter, edit its content, re-generate it, or send it directly.
Select a Denial Status from the dropdown list of statuses you’ve created. Assigning a denial status helps track the current stage of the denial, indicating whether it needs resubmission, review, or has been resolved. Attaching denial statuses is essential for accurately tracking the progress of each denial, especially since denials remain in the Denied/Left Open tab indefinitely.
For example, assigning the denial status allows you to filter by Pending Review to only view encounters awaiting evaluation, or by Completed to see those that have been fully processed.
The Encounter Status column helps you filter encounters by their current status, making it easy to exclude those that are settled or no longer denied.
Managing contractual obligations
We’ve got you covered! We’ll automatically enter the adjustment amount for the following denial codes and make sure the line item is not marked as “Accept & Rework Denial” to prevent unnecessary work for your team:
- CO-237
- CO-24
- CO-253
- CO-144
- CO-59
- CO-96
- CO-132
When you click Save and Post, the denials and their adjustment amounts will be applied directly to the line item. Additionally, for CO-23, the system will automatically set the adjustment amount to $0.00 and line items will not be marked as “Accept & Rework Denial” . This avoids extra work since CO-23 represents an amount paid by another payer and is not a true adjustment.
Choosing not to dispute an adjustment
If you choose not to dispute a specific adjustment, you can simply adjust off the amount instead of initiating a denial rework.
For example, if the adjustment is related to a non-covered service, such as a cosmetic procedure that isn’t included in the patient’s insurance plan, there’s no need to dispute it since the payer correctly denied the charge based on coverage rules.
To get started, locate the line item and enter the adjustment amount in the Adj. field. If the adjustment code was removed, re-enter it in the Adj. Code field.
Choose Select from the Line Item Status dropdown menu. When this status is selected, the line item fields remain editable. It will move the line item to the next payer's responsibility without moving the claim in the Denial/Left Open tab.
Click Save and Post.
Dispute your contractual obligations
If you believe a payer is incorrectly applying your contractual obligations, for example, paying less than the agreed-upon rate for CPT 99213, navigate to the line item, remove the adjustment amount, leave the adjustment code, and select Accept & Rework Denial from the status dropdown. Then click Save and Post to move the claim to your denial queue for further review and potential dispute of the contractual adjustment.
Additional information
To disable Denial Management, navigate to Utilities, select Preferences, and then click Company Preferences.
Toggle Enable Denial Management to Off.
Click Save, then log out and back into the system to apply the preference. Once Denial Management is turned off, line items will no longer be automatically updated from Left Open to “Accept & Rework Denial” for ERA payments, and the adjustment amount linked to the denial code will be automatically applied to the insurance payment.
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