View Account Denial Information

The Account Denials page summarizes denial information for a specific account, including the type and amount of a denial as well as the denial resolution status and date. This page also displays the override history for an account so you can see any changes that were made to the override information, the date of the change, and the user who made the change.

From this page, you can also view detailed descriptions of each denial associated with the account and recommended actions for resolving the denial.

Procedure

Access the Account Denials page.
- Select Go To > Account Research > By Account Number. The Account Research by Account Number page opens.
- Type the account number and click Display Account. The Patient Account Audit page opens.
- Click View Account Denials. The Account Denials page opens.
  - This link only appears on the Patient Account Audit page if there is denial information associated with the account.
  - You can also access the Account Denials (Imported) page from the Assign/Update Collection Information page. For more information about this page, refer to Assign / Update Collection Information.
Review the denial information for the account.
- The primary denial for the account is shaded gray in the Denial History section.
- Data that is bracketed and in italics, such as [Pending], indicates the data was manually overridden.
To view additional denial details, do one or more of the following:
- Select the Show Payor Names check box to view the name of the payor associated with each denial.
- Select the Show Line Item Codes check box to view the specific line item codes, such as the revenue or CPT code, associated with each denial.
- Select the Show Denial Descriptions check box to view a detailed description of each denial.
- Select the Show Recommendations check box to view the recommended action for resolving the denial.
Click Refresh to view the selected details.
Optionally, you can perform the following functions:
- Click View Denial Override History to go to the Denial Override History section of this page.
- Click Add Denial Override to override denial information for this account. For more information, refer to Add a Denial Override.
- Click a link in the Denial Source column to view the Remittance Advice Detail page. For more information, refer to View Remittance Advice Details.
- Click Hide Scroll or Scroll to hide or show the scroll bar in the Denial History section.
- Click Flag Account to display the Assign/Update Collection Information page. For more information about this page, refer to Assign / Update Collection Information.

Field Descriptions

The following table explains the fields on the Account Denials page. .

Field	Description
Account Number	Patient account number
Action Department	Department in the facility responsible for resolving the denial
Active	Indicates whether the denial is currently active: Y or N. Only denials from one source type can be active in any single account. If multiple sources are received for a single account, a ranking system in the Denial Source lookup table determines which source is active.
Actual Discount (Insurance)	Total insurance adjustments for all accounts; Explanation of Benefits (EOB) write-off
Admit Date	Date of admission for the account
Author	User ID of the user who created a user comment
Bill Type	Bill type
Charges	Original charges associated with the denial
Code	Customer defined denial code
CTT Subcategory	The Collections Tracking subcategory associated with the denial. This subcategory allows you to create a worklist in the Collections Worklist page based on this subcategory. Typically, denial management subcategories begin with “DM.”
Dates of Service	The range of date of service from and date of service to for the claim
Denial Amount	Total of denial amounts for active denials as of the latest date
Denial Date	Date the denial was received for the account
Denial Level	Indicates whether the denial was at the claim level (C) or line item level
Denial Source	Source of the denial: 835 or TXN (Transaction)
Denial Type	The highest level of denial grouping that specifies the type of denial associated with the account; options include Final, Information, Pending, and Review
Discount Variance	Expected Discount minus the Actual Discount For Medicare accounts in facilities taking write-downs for GA, GY, and GZ modifiers, the discount variance is calculated as Write-Off Discount minus Total Contractual Writeoffs
Expected Discount	Billed Charges minus non-covered charges, minus Total Expected Reimbursement
Expected Insurance Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data, minus patient liability
Flag	Indicates whether there is a flag associated with the account
Functional Department	Department in the facility where the denial originated
Billed Charges	The total charges incurred for the claim or set of claims that have been repriced
Insurance Payment	The amount paid by the insurance company
Medicare Outlier Date	The date on which Medicare Inpatient claims reach the outlier threshold, based on detail charges
Miscellaneous	Non-billable amounts
Non-Contractual/Other Adjustments	Other, non-insurance adjustments
Non-Covered Charges	The amount of non-covered charges (not disallowed charges)
Notes	Notes associated with a denial override
Other Contractual Write-offs	Other insurance adjustments not included in the discount variance
Override Date	The date the denial override was applied to the account
Patient Liability	The amount the patient is responsible for
Patient Name	Patient name
Patient Payment	Portion paid by the patient
Patient Type	Patient type assigned to the account: Inpatient/Outpatient
Payment Variance	Total Expected Reimbursement minus the actual payment. If the Patient Liability is known, it is calculated as Expected Payment minus Patient Liability minus Insurance Payment. If Patient Liability is unknown, it is calculated as Expected Payment minus (Insurance Payment plus Patient Payment)
Primary Diagnosis	Primary diagnosis code. This field provides a link to additional information about the code. Click the link to view basic information about the code. KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code. Note: You must be a KnowledgeSource subscriber to view ICD-10 code information.
Product/Plan ID	Name of the insurance product
Resolution Date	Date the denial was set to resolved
Resolved	The resolution status of the denial: Resolved or Open
Secondary Product	An insurance policy, plan, or program that pays an additional amount on the portion of a claim not paid by the primary payor
Show Denial Descriptions	Selecting this check box displays a detailed description of each denial
Show Line Item Codes	Selecting this check box displays the specific line item codes, such as the revenue or CPT code, associated with each denial
Show Payor Names	Selecting this check box displays the name of the payor associated with each denial
Show Recommendations	Selecting this check box displays the recommended action for resolving the denial
Total Contractual Write-offs	Total of all adjustments
Total Expected Payment/Adjusted Expected Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Type	The type of denial override applied to the account
Updated	Date the user code/comment was last updated
User	The user who created the denial override
User Code	User-defined code; four digit maximum
User Comment	Information about the account. If the account(s) is flagged, the comment should explain why it is flagged. The limit is 250 characters.
Write-Off Discount	The amount of the write-down discount