Deny Insurance Claims

With the Deny Insurance Claims function you can post claim denials. If an insurance company denies a claim, you must enter the denial to provide an accurate record and to ensure proper functionality of either refiling the claim to the same insurance, filing the claim for the first time to the secondary insurance, or moving the claim amount from the insurance balance to the patient balance.

To deny a claim:

A claim must first be filed to the carrier before it can be denied. If the claim was filed to the selected carrier and you deny it selecting that same carrier, an entry is stored in the patient's Transaction History Detail screen with the date the claim was denied, the carrier that denied it, the Practice Denial Reason, the Insurance Denial Reason code and the amount denied. The Insurance Flag (I) column is marked with a 'D' for the denied procedures.
When you deny a claim from a primary insurance, CGM webPRACTICE checks if there is a secondary insurance on the account. If there is a secondary carrier in effect for the date of service and Y (Yes) is selected in the Bill this Carrier field, or N (No) is selected with a location code override, then the claim for the secondary carrier is immediately placed in the electronic claims submission file or print file. The balance on the claim stays in the insurance balance.
If there is no other policy to be billed, the balance is moved from the insurance balance to the patient balance.

Upon accessing this function, you must first select the patient and then the Insurance Deny screen displays containing the patient's insurance carrier(s) on file. Select the insurance carrier that denied the claim by clicking anywhere in the row containing the insurance policy information.

After you select the carrier, the patient's Transaction History screen displays. Select the transaction you want to deny by clicking anywhere in the row containing the transaction information. NOTE: If you want to deny transactions on a particular case only, select that case from the Case list in the upper-right corner of the screen. The screen will refresh displaying only the transactions for the selected case.

After you select the transaction to deny, the detailed Insurance Deny screen displays containing the information for the selected transaction.

Data Field Information

Prompt	Response	Len
Procedure Code	This field is informational only and reflects the procedure code on the selected transaction.	10
Date of Service	This field is informational only and reflects the date of service of the selected transaction.	10
Diagnosis	This field is informational only and reflects the diagnosis code(s) on the selected transaction.	10
Assignment	If you want to accept assignment on this claim select this check box.	1
Original Amount	This field is informational only and reflects the original charge amount on the selected transaction.	10
Unpaid Amount	This field is informational only and reflects the amount still unpaid on the selected transaction.	10
Practice Reason	Type the code you want or select from the Practice Reason list. This list contains the information stored in the Practice Denial Code Table. This field appears in the Action column of the denial entry on the patient's Transaction History Detail screen along with the Insurance Reason code, if one is entered.	6
Insurance Reason	Type the code you want or select from the Insurance Reason list. This list contains the information stored in the Insurance Denial Code Table. This code appears in the Action column of the denial entry on the patient's Transaction History Detail screen, along with the Practice Reason.	3
Secondary to Paper	If you want to store this claim in the print file to be printed to the secondary insurance, select this check box. Or, you can print it now by selecting the Print Now check box. NOTE: This will not work for UB forms. To print a denied UB form, you must print it from the Print Insurance Forms function.	1
Print Now	If you want to print this claim to the secondary insurance now, select this check box. Or, you can store it in the print file to print later by selecting the Secondary to Paper check box. NOTE: This will not work for UB forms. To print a UB form, you must print it from the Print Insurance Forms function.	1
Deny all Charges for this Accounting Date	If you want to deny all charges posted with this accounting date, select this check box.	1

After you click Save, the screen returns to the Transaction History screen where you can select additional transactions to deny.

NOTE: If you selected the Print Now check box, you must click Cancel from the Transaction History screen to access the Printers dialog box. If you choose Print Here from the Printers dialog box to print the claim to the screen, the print job minimizes down to the Status bar at the bottom of the screen, so you must select it from there.