Version 21.3
Path: Tools tab > Reporting button > Financial Analytics > Denials
When to Use this Report
Use this dashboard as a tool to track and analyze claim denials at the claim and line item level. This dashboard provides a comprehensive view of denied claims by adjustment codes, payers, CPT codes, location, and monthly denial trends. It is powered by posted ERAs and driven by adjustment codes classified as 'denials' in the HIPAA Codes > Claim Ajdust Code library.
The worklist section of the dashboard enables you to view fully adjusted denials, partially adjusted denials, and adjustment codes flagged for review.
Qualifications/Best Practices
Based on the CARC code (Claim Adjustment Reason Codes) configuration. Dashboard is looking to the HL7 setup and which codes are set to a match status of 'Denied'.
About Denial Summary and Worklist
Denial Summary Filters and Summary Tiles
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Number |
Section | Description |
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1
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Provider | Use this filter to select a provider(s) associated with the transactions. |
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2
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Location | Use this filter to select the Location(s) of the associated transactions. |
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3
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Denied Charges | This summary tile shows the dollar amount of charges associated with a denied adjustment code (defaults to the last 90 days by DOS). |
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4
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Count of Line Item Denials | This summary tile counts the number of denied lines at the CPT level (defaults to the last 90 days by DOS). |
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5
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Count of Claim Denials | This summary tile counts the number of denied lines at the Claim level (defaults to the last 90 days by DOS). |
Denial Summary Overview
| Denials by Adjustment Code | Denials by Payer (fully adjusted) |
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Type of report: Pie Chart Displays: This shows the top 10 denials by adjustment code posted during ERA processing .
Details: Hover over each section to see the specific adjustment codes.
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Type of report: Pie Chart Displays: Top 10 denials by payer and summed adjudicated amount.
Details: Hover over each section to see the specific payers.
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| Denials by Provider | Denials by CPT |
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Type of report: Bar Graph Displays: This shows the top 10 denials by provider and summed adjudicated amount.
Details: Hover over each bar to see the specific adjudicated amount.
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Type of report: Line Chart Displays: This shows the top 10 denials by CPT and summed adjudicated amount, as well as the total denials.
Details: Hover over each CPT code to see the specified denial charges.
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| Denied Charges MoM Trend | Denials by Location |
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Type of report: Line Chart Displays: This shows the Month over Month denial trends by denied charges.
Details: Hover over each point to see details. Also shows the percent trend over month.
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Type of report: Bar Graph Displays: This shows the denials by location and summed adjudicated amount.
Details: Shows the top ten locations by default.
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Denial Worklist
Denial Worklist Filters
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Number |
Section | Description |
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1
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Date of Service
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Use this filter to select the date(s) you wish to search based on the date of service. See the Dates section of the Filter Tutorial article for the different selections.
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2
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Provider
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Use this filter to select a provider(s) associated with the transactions.
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3
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Payer
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Use this filter to select the Payer(s) associated transactions.
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4
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Location
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Use this filter to select the Location(s) of the associated transactions.
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Denial Worklist Reports
The Worklist filters at the top of the page will be applied to all worklist reports. You can also filter further in each worklist by Adjustment Code, CPT Category, Patient, and/or Claim number.
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Fully Adjusted Denials
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| Displays: This is a worklist of all line items posted via ERA and have an adjustment code that is marked as denied in the HIPAA Codes library and the line item balance is at $0.
Details:
• Filter by Adjustment Code, CPT Category, Patient, and/or Claim #.
• The Summary shows the Total Adjusted for all line items pulled in the filtered report.
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Partially Adjusted Denials
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| Displays: This is A worklist of all line items posted via ERA and have an adjustment code that is marked as denied in the HIPAA Codes library and the line item balance is > $0..
Details:
• Filter by Adjustment Code, CPT Category, Patient, and/or Claim #.
• Summary Amounts: The Summary amounts at the bottom are the totals for each of the respective columns of all line items pulled in the filtered report.
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Review ERA Match Status
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| Type of report: Bar Graph
Displays: A worklist of all line items posted via ERA and have an adjustment code that is marked as "Review" in the HIPAA Codes library . Details:
• Filter by Adjustment Code, CPT Category, Patient, and/or Claim #.
• Summary Amounts: The Summary amounts at the bottom are the totals for each of the respective columns of all line items pulled in the filtered report.
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