Denials

A denial is a service the payer processed but did not pay. Denials come from remittances posted in Payments, and you can record one from a paper explanation of benefits. Open Denials in the Billing panel of the main menu. You need the permission to work rejections and denials.

The worklist#

Each row shows its priority, the claim and service, the patient, the payer, the denial codes (group, reason and any remark codes), the amount, the date and the follow-up date. The highest priority comes first. Click a column header to sort by it.

Priority#

Every denial gets a priority from 0 to 100 so you work the ones most worth your time first. Hover the number to see what drove it; the most important reason shows beside it. The score weighs:

• How often its kind of denial is recovered. Authorization, missing information, coding and eligibility denials are usually fixable; duplicates, late filing and services the plan does not cover rarely are.
• The amount denied. Larger amounts score higher, up to $2,000.
• How long it has waited, up to 90 days.
• The filing deadline: the earlier of the payer's corrected claim limit, counted from the date of service, and its appeal window, counted from the denial date, both from its rule set.

A follow-up date that has come adds 10 points, and a deadline within 14 days lifts the score to at least 80. An appealed denial drops while you wait for the payer's answer, until its follow-up date comes. Past the deadline the deadline adds nothing.

NeatPractice sorts each denial into a category from its reason code (eligibility, authorization, coding, duplicate, timely filing, medical necessity, coordination of benefits, missing information, not covered or provider enrollment) and shows a suggested next step under the codes.

Narrow the list with Status and Category, and turn on Follow-ups due to see only the denials whose follow-up date has come. Pick patients in the patient panel to see only theirs. Without a status filter the list shows open, in-progress and appealed denials.

Record a denial from paper#

Open the claim and choose Record Denial in its header menu. Pick the denied service (or the whole claim), the group and reason code, any remark codes separated by commas, the amount and the date. The date cannot be after today at the claim's location. The same denial is never added twice.

Work a denial#

Choose Work Denial in the row menu to:

• set the Status: Open, In progress, Appealed, Resolved or Written off;
• assign an Owner from your team;
• set the Follow up on date;
• record the date the appeal was sent;
• add a Note. Resolving or writing off a denial needs a note saying how it ended.

The money itself is posted in Payments; the worklist tracks the follow-up.

Appeal letter#

Choose Appeal Letter to download a reconsideration letter for the denial: your billing office's details, the payer's claims address, the patient, claim and service, the denial codes, and wording that fits the denial's category. Sign it and send it with the records it mentions.