Denial Worklist Overview
A Payer Rejection is not the same as a Payer Denial. A rejection gets kicked back before it enters the Payer's system. A Denial has been adjudicated, and Payment has been denied.The Denial Worklist is populated when an ERA is applied, and at least one line item on the Remit has a zero dollar Payment and is statused to DW on the ERA Remit Items screen.
- The Denial Worklist is interactive with links to the:
- Encounter Dashboard
- Patient Dashboard
- ERA
- Remit
- Receipt
- In the Claim Type column, the plus icon can be used to:
- View whether this is a Primary, Secondary, or Tertiary Payer.
- Line item details
- CARC and RARC codes
- Charge, Allowed, and Paid Amounts
- Tags Column: Displays Tag(s) if the Encounter has one or more Tags attached to it.
- Use the Filter Criteria to define the content of the list.
- (Home > Denials button in the Actions panel.
- There are fewer options on this Worklist than the other Worklists in the System.
- If you want more options when working the DW, the Remit can be added to another designated Worklist using the ERA Remit Items screen.
Example of DW: ERA 1532 was Applied. Encounter 5081 was denied and did not Post. It was placed on DW by the System due to a zero dollar Payment.
Access the Encounters on Individual ERAs placed on the Denial Worklist
- From the the ERA List screen by selecting the number in the DW Column;
- On the ERA File Dashboard by selecting the number in the DW box;
Access all Encounters on the Denial Worklist
- On the Home Dashboard, select the Denials button.
- Enter dw in the Navigation Search Box.
Denial Worklist Filters
The Filters can be used to narrow the DW list.
- View: Summary or Detailed view.
- Remit and ERA: Enter a Remit or ERA Number.
- Patient: Enter a Patient ID or use the Lookup icon to search for a Patient.
- Include Zero Balance Encounters: Select the checkbox to include Encounters that have a zero balance.
- Encounter, Receipt, Insurance, Denial Code, Facility, Rendering, and Billing: Use the Lookup icon on the respective fields to filter for specific items.
- Takebacks: The options are Inclusive, Exclusive, Only
- DOS From and DOS To: Search using a range of Dates of Service.
- Patient and Insurance Bal >= and <=: Filter for specific balances.
- Charge, Paid, Applied, and Unapplied Amounts >= and <=: Filter for the specific criteria using greater than/equals to and/or less than/equals to.
- Unapplied Only: Select the checkbox to view unapplied Payments only.
- Include Inactive: Select the checkbox to include Inactive Patients.
- Tags and Tag Attributes: Search by Tags and/or Tag Attributes.
- Resolved Tags: Include, Exclude, or Only.
Denial Worklist Columns
- Interactive Columns: Remit, Patient, Encounter, ERA, and Receipt
- Other Columns
- Name: Patient's Name
- Assigned Encounter Tags
- These Tags also display on the Encounter
- There is a flag on the Encounter showing that the Encounter is on the Denial Worklist.
- Facility: The office where the Patient was seen.
- Encounter Insurance: The Patient's Insurance on the Encounter
- Ins Bal and Pat Bal: Insurance and Patient Balances
- Claim Type: How the Claim was processed: Primary, Secondary, or Tertiary
- Lines: Number of Line Items on the Claim
- DOS: Encounter Date of Service
- Charge: Total Amount of Charges on the Claim
- Paid: Total Amount that has been paid
- Applied and Unapplied: Amounts of the Total Paid that have been applied and unapplied.
Example of On Hold Remits on the ERA Remit Items screen:
- ERA 1528 was Applied.
- Three Encounters did not Post and were placed on Hold by the System.
- Remit 7936, Encounter 6806, was placed On Hold because a credit would be created if posted.