Maintain Practice Denial Codes

With the Maintain Practice Denial Codes function you can review information for a specific code, add new codes to the table, change the information for existing codes, print the table, and inactivate or reactivate a code.

The Practice Denial codes are tracked in the Insurance Collections Module. In the Payment Entry function the Practice Denial Reason is required and displays on that payment line in the patient's insurance ledger. The Denial Type for each code is used when manually posting payments to determine how the balances should be processed; they do not affect payments posted for ERA's.

Upon accessing this function, the Maintain Practice Denial Codes screen displays containing blank data fields.



Data Field Information
Prompt Response Req Len
Denial Code Type the code you want or click the magnifying glass to search the table. This code cannot begin with a zero.   6
Description Type a description of the code. This description will be displayed for any procedure that was denied when reviewing the patient's insurance ledger in transaction history on a patient's account. 45
Denial Type Select the denial type option applicable to this code. The Denial Types only affect manually posted payments, NOT ERA posted payments.

When you post a Practice Denial Code that is marked as an 'Insurance' denial type, the balance will stay in the insurance balance and a secondary claim, if applicable, will not be generated.

When you post a Practice Denial Code that is marked as a 'Patient' denial type, the balance will move to the patient's responsibility or a secondary claim, if applicable, will be generated.		   1

After you Save the code, the information refreshes on the screen.

Inactive Codes - If you select a code that has been inactivated, CGM webPRACTICE displays the existing information for the code but the data fields will be unavailable and you cannot make any changes. Reactivate will be the only active function in the Action Column. You must reactivate the code before you can change any of the data stored for the code.

If you are the System Manager for CGM webPRACTICE, you should limit access to the Maintain function to select staff members. You should also provide guidelines (customized to your practice) to these staff members for entering table data in a consistent manner. This should protect the integrity of your table information.

Use the Action Column functions to edit or create codes. To create new codes or edit existing codes in the table, a user must have the Allow Table Update check box selected in Maintain Users under System, User Management, and be given the appropriate security level. For additional information about security levels, see the Function Security Menu under System, User Management. For setting up user codes, see Maintain Users. If the Maintain function is accessed and the user is not authorized to 'Allow Table Update', the New, Inactivate, Reactivate, and Save functions in the Action Column will be unavailable. These functions will appear dimmed on the screen and the user will only be allowed to Review codes. If the user does not have the appropriate security level to access the Maintain function, codes can also be reviewed using the Review a Practice Denial Code function.

Action Column Functions
The Action Column functions are provided so you can perform multiple functions quickly and efficiently from within the Maintain function.

Select - Displays a new screen with blank data fields so you can select another code.

New - Displays a new screen with blank data fields so you can enter the information for a new code.

Next - Displays the next code in the table. If you are viewing the last code in the table and click Next, CGM webPRACTICE returns to the main Tables menu. If you make changes to the table and click Next, the changes will not be saved. You must click Save to save the changes before proceeding to the next table item.

Previous - Displays the previous code in the table. If you are viewing the first code in the table and click Previous, CGM webPRACTICE returns to the main Tables menu. If you make changes to the table and click Previous, the changes will not be saved. You must click Save to save the changes before proceeding to the previous table item.

Print - You can print all or part of the contents of the table. For additional information on printing, see Print the Practice Denial Table.

Inactivate - Immediately inactivates any active code currently displayed on the screen. When you inactivate a code in the table, it is not actually removed from the table but is assigned an inactive status. CGM webPRACTICE needs to retain information about the inactivated code for any data that was previously entered with that code. After a code has been inactivated you cannot use it for any data entry operation. An entry will be logged in the Changes to Table category in the System Log under System, File Maintenance, Look-Up Functions.

Reactivate - Immediately reactivates any inactive code currently displayed on the screen and allows it to be used in data entry again.