Denials Report

Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library. Click the Other tab. In the Standard Reports section of the tab, click run next to Denials Report.

To access reports on the Other tab of the Report Library, you must have the Report: Report Library: Other permission. This permission is included in the following roles:

• Practice Superuser role
• Report Reader role

Note: To activate the Denials report, use the Activate Reports page.

1. Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library.
2. Click the Other tab.
3. Click run next to Denials Report in the Standard Reports section of the tab.
   The Run Report: Denials Report page appears.
4. Date Range — Enter the start and end dates for the report, or select a date range from the menu.
5. Date Range by — Select an option from the menu. The date range applies to the option you select in this field.
• Denial Date — Include only denials that occurred during the selected date range.
• Date of Service — Include only denials associated with claims whose date of service occurred during the selected date range.
6. Denial Type — By default, the report displays denials with the Scrub type only. To report on other denial types, click Selected and then select the denial types: Scrub, Front End, or Back End.
7. Athena Kickcode or Claimrule ID — To report on specific kick codes or claim rules only, enter the kick codes or claim rules in the box.
8. Show all Kickcodes/Claimrules — By default, the report displays the name of the kick code or claim rule for each denial in the report. You can deselect this option.
9. Show descriptions — To display the description of the kick code or claim rule for each denial in the report, select this option.
10. Rejection Reason — To report on denials for specific rejection reasons only, click Selected and then select the rejection reasons from the list.
11. Transfer Type — To report on denials for primary insurances or secondary insurances only, click Selected and then select Primary or Secondary from the list.
12. Insurance Package — To report on denials for specific insurance packages only, click Selected, enter text to display a list of matching insurance packages, and then select the packages from the list.
13. Insurance Reporting Category — To report on denials for specific insurance reporting categories only, click Selected and then select the IRCs to include in the report.
14. Custom Insurance Grouping — To report on denials for specific custom insurance groups only, click Selected and then select the custom insurance groups to include in the report.
15. Rendering Provider — To report on denials for specific rendering providers only, click Selected and then select the rendering providers to include in the report.
16. Supervising Provider — To report on denials for specific supervising providers only, click Selected and then select the supervising providers to include in the report.
17. Supervising Provider Specialty — To report on denials for specific supervising provider specialties only, click Selected and then select the specialties to include in the report.
18. Provider Group (Rendering) — To report on denials for rendering providers in specific provider groups only, click Selected and then select the provider groups to include in the report.
19. Service Department — To report on denials for specific service departments only, click Selected and then select the service departments to include in the report.
20. Service Department POS type — To report on denials for service departments with specific place of service types only, click Selected and then select the place of service types to include in the report.
21. Show Department Group — To display the department group of the service department for each denial in the report, select this option.
22. Claim Status — To report on denials associated with specific claim statuses only, click Selected and then select the claim statuses to include in the report.
23. Procedure Codes — To report on denials for specific procedure codes only, click Selected, enter text to display a list of matching procedure codes, and then select the procedure codes from the list.
24. Show all Procedure Codes — To display the description of the procedure code associated with each charge-level denial in the report, select this option.
    Note: For claim-level denials, this field in the report is always blank.
25. ICD-9 Diagnosis Code 1 — To report on denials associated with specific primary ICD-9 diagnosis codes only, enter up to four ICD‑9 diagnosis codes in the boxes.
    Note: To search for a code, type a period to display the Diagnosis Lookup tool.
26. Show all ICD-9 Diagnosis Code 1 — To display the primary ICD-9 diagnosis code associated with each denial in the report, select this option.
27. ICD-9 Diagnosis Code 2 — To report on denials associated with specific secondary ICD-9 diagnosis codes only, enter up to four ICD‑9 diagnosis codes in the boxes.
    Note: To search for a code, type a period to display the Diagnosis Lookup tool.
28. Show all ICD-9 Diagnosis Code 2 — To display the secondary ICD-9 diagnosis code associated with each denial in the report, select this option.
29. ICD-10 Diagnosis Code 1 — To report on denials associated with specific primary ICD-10 diagnosis codes only, enter up to four ICD‑10 diagnosis codes in the boxes.
    Note: To search for a code, click the magnifying glass icon .
30. Show all ICD-10 Diagnosis Code 1 — To display the primary ICD-10 diagnosis code associated with each denial in the report, select this option.
31. ICD-10 Diagnosis Code 2 — To report on denials associated with specific secondary ICD-10 diagnosis codes only, enter up to four ICD‑10 diagnosis codes in the boxes.
    Note: To search for a code, click the magnifying glass icon .
32. Show all ICD-10 Diagnosis Code 2 — To display the secondary ICD-10 diagnosis code associated with each denial in the report, select this option.
33. Show Claim ID — To display the claim ID associated with each denial in the report, select this option.
34. Show Patient ID — To display the patient ID associated with each denial in the report, select this option.
35. Show Denial Date — To display the denial date associated with each denial in the report, select this option.
36. Show DOS — To display the date of service for the claim associated with each denial in the report, select this option.
37. Show Total Charge Amount — Select this option to display the denied amount for each denial in the report.
• For charge-level denials, this amount is the charge for the denied procedure code.
• For claim-level denials, this amount is the total charge on the claim.
38. Show Denial Level — To display the denial level — CHARGE or CLAIM — for each denial in the report, select this option.
39. Report Format — Select the format for your report results.
• HTML table — Display the report results on your screen.
• Text (tab-delimited) — Export the report results to a .csv file in tab-delimited format.
• Text (comma-delimited) — Export the report results to a .csv file in comma-delimited format.
40. Report Options — Select report options.
• Suppress Column Headings — Select this option to remove column headings from the report results.
• Suppress Report Name — Select this option to remove the report name from the report results.
• Show Filter Criteria — Select this option to include your selected filter criteria in the report results.
• Run Offline (will appear in your Report Inbox tomorrow morning) — Select this option for very long reports. Reports that are run offline appear in your Report Inbox the morning after the request.
41. Click Run Report.

In athenaOne, a denial is a type of kick, or note, indicating that a claim will not be paid, adjudicated, or sent to the payer until corrections are made or additional information is sent. Denials transfer responsibility from one party to another in the claim life cycle. You can use the Denials report to view denial and scrub events in detail.

Note: Zero-pay claims are fully adjudicated and closed. For this reason, zero-pay claims are not considered denials in athenaOne and do not appear in the Denials report.

In athenaOne, denials have a type: front end, back end, or scrub.

• Front-end denials occur prior to payer adjudication. The intermediary can deny the claim — generally for format issues — or the payer can deny the claim. Because front-end denials occur before adjudication, athenahealth generally receives these denials within a week.
• Back-end denials occur as a result of payer adjudication. The payer has processed the claim in a lengthy adjudication process and determined that it will not pay the claim.
• Denials with a type of "Scrub" occur because athenaOne prevents a claim from being submitted due to potentially invalid claim data.

Scrubs work on claims and charges as follows:

• Claim, ClaimCreate, or Charge scrubs run on a claim or charge. This type of scrub finds applicable rules, runs the rules on the claim or charge, and interprets and collates the output.
• A rule can scrub a claim or charge; that is, the rule checks the data on the claim or charge and applies logic to change the data or change the status of the claim for verification purposes.

For more information, see Claim Rules; Kick Codes, Kick Reasons, and Claim Rules; and View Kick Reasons.

Counting claims as denied

 

A charge-level denial for a partially adjudicated claim does not cause the claim as a whole to be marked as denied. If the charge-level denial does not move the claim's status out of BILLED, athenahealth does not count the claim as denied. For example, if you send CPT II codes to Medicare, you may see certain codes denied without that denial changing the claim status; the remainder of the claim is adjudicated and paid as expected.