Recording denial codes on a payment for a claim on an ERA

To help you track and manage claims on ERAs that get returned with denial codes, when a payment for a claim on an ERA is posted automatically, quickly, or manually, if procedures on the claim have denial codes, those denial codes are added automatically to the applicable procedures for the claim payment. Also, when you are manually posting or editing a claim payment, you can select additional and/or remove denial codes for procedures on the claim as needed. Each procedure on the claim can have up to three CARCs (Claim Adjustment Reason Codes) and up to three RARCs (Remittance Advice Remark Codes).

Notes:

• You can also record denial codes on an insurance payment from a patient's Ledger page.

• The list of available denial codes is not customizable.

To add and/or remove denial codes

1. While you are manually posting or editing a claim payment, expand each procedure for which you want to add and/or remove denial codes (by clicking, or tapping, the downward-pointing chevron), or expand all the procedures at once (by clicking, or tapping, the downward-pointing double chevron).

   • In the Enter Claim Payment dialog box.

     

     With one of the procedures expanded.

     

   • In the Edit Claim Payment dialog box.

     

     With one of the procedures expanded.

     

2. Do any of the following:

   • To add claim adjustment reason codes (CARCs) to a procedure, click (or tap) in the Reason Code box to view the list of codes, and then select up to three claim adjustment reason codes.

     

     Note: To search for a code, in the box, begin typing a code or part of a description (not case sensitive). Only the matching codes appear in the list. Continue typing as needed to narrow down the list.

     

   • To remove a claim adjustment reason code (CARC) from a procedure, click the corresponding X .

   • To add remittance advice remark codes (RARCs) to a procedure, click (or tap) in the Remark Code box to view the list of codes, and then select up to three claim adjustment reason codes.

     

     Note: To search for a code, in the box, begin typing a code or part of a description (not case sensitive). Only the matching codes appear in the list. Continue typing as needed to narrow down the list.

     

   • To remove a remittance advice remark code (RARC) from a procedure, click the corresponding X .

3. Repeat steps 1-2 as needed for other procedures.

4. Finish setting up other options for the payment as needed, and then click (or tap) Save.