Enhanced denial management workflow

RXNT’s enhanced denial management workflow makes it easier to dispute denials. All ERAs are scanned for denials and automatically “left open” for easy identification. The adjustment amount associated with a denial is removed, with the rest of the insurance balance remaining intact. All items marked as left open will be moved to the denial queue so your team can rework the claims and receive maximum reimbursement.  

Take a look 

 To view denials, click on an insurance payment that was generated from an ERA.

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Click on a patient and select the encounter you want to review.

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If a line item in the encounter contains a denial adjustment code, the Leave Open box will be checked. 

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The adjustment amount for the corresponding denial is $0.00.

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Click Save and Post to move the denial to your denial management queue. 

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Don’t want to dispute an adjustment?

 Scroll to the top of the insurance payment screen and click Print ERA to find the original adjustment amount.

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Navigate to the line item in question to add the adjustment amount and deselect “Leave Open.” 

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Click Save and Post and the payment will post with the denial.

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What about my contractual obligations?  

We’ve got you covered! We’ll automatically enter the adjustment amount for the following denial codes and make sure the Leave Open box is not checked to prevent unnecessary work for your team: 

  • CO-237 
  • CO-24
  • CO-253
  • CO-144

When you click Save and Post, the denials and their adjustment amounts will be posted to the line item. 

 We’ll also automatically make the adjustment amount $0.00 for CO-23 and leave the Left Open box deselected. This will prevent additional work for your team since this represents the amount paid by another payer and is not a true adjustment.

What if I need to dispute my contractual obligations? 

Navigate to the line item in question to remove the adjustment amount and select “Leave Open.” 

Click Save and Post to move this to your denial queue. 

 

Still need help? Contact us!

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