Add a Denial Override

Use the Denial Override page to override the denial type or the current resolution for a selected denial.

  1. Access the Denial Override 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.

      • Note: You can also access the Patient Account Audit page from the Account Worklist. For more information, refer to View the Account Worklist .

    • Click View Account Denials. The Account Denials page opens.

      • Note: This link only appears on the Patient Account Audit page if there is denial information associated with the account.

    • Click Add Denial Override. The Denial Override page opens.
  2. To override the denial type, select the Denial Type check box and then select a denial type from the list. Options include the following:
    • Final
    • Information
    • Pending
    • Review
  3. To override the resolution status, select the Resolved check box and then select a Yes or No from the list.
    • Typically, when changing the denial type to Final, you should also change the resolution to Yes.
  4. Click Update. Your changes are reflected in the summary section below the check boxes.

    5. Note: Data that is bracketed and in italics, such as [Pending], indicates a manual override.

The following table explains the fields on the Denial Override page.

Field

Description

Account Denial Information

This section displays the details for the account-level denial information

Account Number

Patient account number (for UB claims) or insured ID (for CMS-1500 claims)

Code

Customer defined denial code

Denial Amount

Total of denial amounts for active denials as of the latest date

Denial Date

Date the denial was applied to the account

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

Primary Denial Information

This section of the table displays the details for the primary denial associated with the account

Resolved

The resolution status of the denial: Resolved or Open