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Maintain Insurance Denial Codes

With the Maintain Insurance Denial Codes function you can review or change information for existing codes or print the table. You cannot add codes to this table. This table already contains all of the 'M' and 'N' remark codes as issued annually by the Centers for Medicare and Medicaid Services (CMS) and are automatically loaded into the system as they become available.

You should also link these Insurance Denial codes to the codes in your Practice Denial Code Table by selecting an Equivalent Code. A Practice Denial code can be linked to multiple Insurance Denial codes. You should go through this table and tie your more commonly used Insurance Denial codes to your Practice Denial codes.

The Insurance Denial codes and the Practice Denial codes are tracked in the Insurance Collections module. In Payment Entry, the Practice Denial Reason is required and the Insurance Denial Reason is not. If you post the denial using both reason codes, they will both show on that payment line in the patient's insurance ledger.

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

Data Field Information

Prompt	Response	Len
Denial Code	This field is informational only and reflects the denial code.	10
Brief Description	Type a brief description of the Insurance Denial code.	55
Long Description	Type a long description of the Insurance Denial code.	55*5
Practice Denial Code	Type the equivalent code you want or select from the list, which contains your Practice Denial Code Table.	5
Auto Adjustment (ERA)		1
Auto Post $0 Payment (ERA)		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 an Insurance 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 Insurance 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.