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, it will defaults to Accept & Rework Denial, expect for CO-23 and CO-132. 

• • When the denial code is CO-23 or CO-132, the adjustment amount is $0.00 and the status remains Select.
  • All other denial code continue to default 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:

• • 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 their respective tabs and are enabled by default. This ensures that only encounters tied to active denials or left-open line items are displayed. These include claims associated with payments that have a status of Awaiting Payment and Ignore Line Item, as well as denials. 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.

By default, all columns are selected to provide a comprehensive view of claim and encounter details. However, you have the flexibility to deselect any columns that are not relevant to your workflow, allowing you to simplify the display, reduce clutter, and focus on the data that matters most for your reporting and analysis needs. To adjust your columns, click Columns, then uncheck the box next to each column you wish to hide, and then click OK to save your changes.

In addition, when Report Mode is selected, you have the option to display additional columns that provide greater insight into claim and encounter activity. While the default columns give a broad overview, these extra columns allow you to track more detailed information, helping you identify trends, monitor balances, and follow up on outstanding issues more efficiently. 

For example, you might choose to display:

• • Encounter Balance - Shows the current balance for each encounter, giving you immediate visibility into remaining balances without opening individual records. 
  • Latest Insurance Payment Posted Date - Displays the date of the most recent insurance payment applied to the encounter, giving visibility into recent transactions. 
  • Most Recent Encounter Note Date - Indicates when the last note was added to the encounter, helping you track undated or communications regarding the claim.
  • Place of Service - Displays the code and description of where the service was performed, which can be useful for reporting, billing, or auditing purposes. 

You can further enhance the organization of your data in the grid by grouping columns. To group by a specific column, select the column name and drag it into the designated grouping area at the top left of the grid. You can group by multiple columns by dragging additional column names into the grouping area in the order you want then applied. 

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. Appeals are typically submitted to payers after a claim has been denied or underpaid and there is a valid reason to challenge the payer’s decision.

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 view only 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: Authorization or referral issue

• • Rework and verify authorization

CO-24: Covered under capitation

• • No rework needed.

CO-253: Sequestration, reduction in federal payment

• • The system will automatically write off the amount.

CO-144: Incentive adjustment, e.g., based on a payer's performance program

• • The system will automatically write off the amount.

CO-59: Processed based on multiple or concurrent procedure rules

• • The system will automatically write off the amount.

CO-96: Non-Covered charges

• • The system will automatically write off the amount.

When you click Save and Post, the denials and their corresponding adjustment amounts are applied directly to the line item. However, not all denial codes are handled the same way.

Codes such as CO-23 and CO-132 remain in a review state instead of moving to rework. For these codes, the system automatically sets the adjustment amount to $0.00, and the line items are not marked as Accept & Rework Denial. 

This reduces unnecessary work, as CO-23 and CO-132 reflect amounts paid by another payer and are not considered true adjustments. 

CO-23: Another payer already paid this amount

• • Do not rework, leave as Select.

CO-132: Negotiated/expected adjustment from payer

• • Review only, do not write off automatically.

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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