Denial Analysis Reporting

Denial Analysis Reporting


Denial Analysis Reporting

This Report provides high-level reporting based on the CARC Management Setup. You can identify and categorize meaningful denials by setting up CARC Denial Rules.


Date Span

  1. Select a Date option, such as Previous X Months which defaults to 1 month, which can be changed, or select Date Range to enter your own dates.
    1. Example: If Previous 1 Month is selected, change the 1 to 3 to see the previous 3 months.


Data Type

  • Date of Service
  • Post Date
  • Billed Date

Role

A Role is the Payer who is responsible for Payment in the claim's processing progression.

  • The default is All.

  • Select a specific Role from the dropdown.

  1. All
  2. Primary
  3. Secondary
  4. Secondary or Tertiary
  5. Tertiary


Top Denials

To show only the Top Denials on the Report, select the number of Top Denials to display on the report output.

  • All (default), 5, 10, 25, 50, or 100


Filters to Include or Exclude

You can choose to Include or Exclude the following Filters.

  • If nothing is specifically included or excluded, all of the fields will be reported.

  • Example 1: You want to exclude Insurances, Medicare and Medicaid.

    • Select the inc button to change to exc.

    • Use the Lookup icon to find Medicare and Medicaid.

    • Medicare and Medicaid will be excluded, but all other fields will be reported.

  • Example 2: Audit the Denials by the User who completed the Encounter or who manually entered the Charges on the Encounter.

    • Select the User using the Lookup icon or enter the User's ID.



Other Fields

Preventable/Non-Preventable

On the report, Preventable and Non-Preventable CARC Code Denials are in their own sections.

  • You have the Options to Include, Exclude or Only report the Preventable denials.
  • The CARC codes are set up as Preventable in the  CARC Management Rules.


Primary CARC

The Primary option is selected on the CARC in CARC Management Library.


  • A Primary CARC is the CARC with the highest adjudication.
  • A Non-Primary CARC will be considered as the Primary when it is the only CARC being adjudicated.
  • If there are only Non-Primary CARCs, the CARC with the highest adjudication will be considered as the Primary.
  • Options:
  • Include (default): Include all CARCs that are considered as Primary.
  • Exclude: Exclude all CARCs that are considered as Primary.
  • Only: Show only CARCS that are considered as Primary.


Multiple Denials

When a Procedure line has multiple denial lines, select how the denials should display. This report will only show Denials within the time frame you have selected.

  • Include All (default): All lines will display.
  • Highest Adjudicated Only: Only count 1 denial line per Procedure line.
  • This is determined by the greatest denial value.
  • All other lines will be removed from the report.
  • Highest Adjudicated Only (Sum Totals): Only count 1 denial line per Procedure line.
  • The Denial Amount is the sum of the Procedure with the highest value and the other lines that were removed.

This filter will only display the denials within the time frame selected.

Subsequent Denials

The same Procedure line on the same Encounter with multiple denials occurring on Remits with different dates.

Example: A Line Item was denied on a Claim, and a Corrected Claim was resubmitted to the Payer, who denied it again.

  • Include (default): All subsequent lines will display.
  • Exclude: All lines after the first denial will be removed from the report.
  • Only (Include Original Denial): Only display Encounters that have Subsequent Denials.
  • This includes lines that qualify as Subsequent, including the original line.
  • Only (Exclude Original Denial): All Subsequent Denials will be reported, but the Original Denial will not be included. 

This filter will only display the denials within the time frame selected.

Posted, Posted as Note, and Not Posted

The Denial Date is determined by the Posted status of the Denial.
  1. If the Denial is posted, the Denial Date is the Posted Date.
  2. If the Denial is not posted, the Denial Date is the ERA Loaded Date.
On each of these fields, there are options to Include, Exclude or Posted Only.


Category

You can select a Category for reporting purposes.

  • All
  • CE: Charge Entry
  • CM: Contract Management
  • CS: Claims Submission
  • DC: Documentation & Coding
  • R: Registration
  • UM: Utilization Management


Report as RARC

Select to Include, Exclude, or Only show the codes that were designated in the CARC Denial Rules to use RARC instead of CARC.

Processed As

Designate how the Denial was Processed.

  • All
  • Primary
  • Primary Forwarded
  • Secondary
  • Secondary Forwarded
  • Tertiary
  • Denial
  • Reversal

Balance

  • Insurance or Patient: Either one or both have a balance.
  • Insurance: Insurance Balance only.
  • Patient: Patient Balance only.


Group By and Subgroup By

  • Facility
  • Facility Group
  • Insurance
  • Insurance Group
  • Billing
  • Billing Group
  • Rendering
  • Rendering Group
  • Procedure
  • Procedure Group
  • CARC
  • RARC
  • Category
  • Encounter Completed by User


Sort By

  • Denial Count
  • Denial Amount

Totals Only

  • Uncheck to see Details.


Display CARC Description

  • Check to display the full CARC Description.


Page Break on Section

  • Check to page break Preventable between Non-Preventable.


Send to Encounter Worklist

Select a Worklist from the drop-down to send the results of the report to a Worklist for follow-up.



Learn More

CARC Management and Denial Analysis Overview

CARC Management Denial Rules

Denial Analysis: Preventable/Non-preventable Denials





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