Working denied and rejected claims

Every denied or rejected claim becomes an item on EHR, Revenue Cycle, Denial Work Queue, opened by the daily job, with what kind of denial it is and what usually fixes it.

• The kind (eligibility, authorization, coding, missing information, duplicate, timely filing, medical necessity, coordination of benefits) is read from the payer's reason code.
• A front-end rejection is due in three days, a payer denial in ten.
• A claim gets one open item, however many times it is denied.

1. Correct the claim.
2. Press Resubmit on the work item. A denied claim goes as a replacement claim naming the payer's claim number; a rejected one goes again as an original.
3. Or set the status to appealed, written off or closed, and say what was done.