Resolving Denials in the Corrections Queue

This feature must be activated for your database by Clinicient. If you have questions about whether this functionality has been enabled for your practice, please reach out to Clinicient support.

Claims that have been denied for reasons relating to authorization and coverage are automatically moved to Not Ready status. When this happens, a message will appear in the Corrections Queue notifying you that the claim has been denied and explaining the reason why.

After the necessary information has been corrected:

  • The claim will either automatically move to Billable status, or will remain at Not Ready status.
  • If the claim stays at Not Ready, a system-generated task assigned to the Billing Role will be created prompting the billing team to resubmit the corrected claims.
  • For Total INSIGHT users, Clinicient's billing team will take the final steps to resubmit claims and complete the task.

If you think the claim was denied in error, please see the section below on Troubleshooting Claims Denied in Error.

Note: After the denial EOB is posted, there will typically be a 10 minute delay before the claim updates to Not Ready status and a message appears in the Corrections Queue. If you do not see a Corrections Queue message regarding a denial for one of the reason codes listed below, wait a few minutes and then click the Refresh button in your Tasks tab in INSIGHT EMR.

Expand the denial reason codes in the list below for an explanation of why the claim was denied, what information must be corrected, and next steps to be taken after corrections are made.

 

Troubleshooting Claims Denied in Error

Note: This sections applies only to Total INSIGHT customers.

If you are unable to move a claim from the Corrections Queue and believe the payer denied the claim in error, please follow the steps below.

  1. Create a new task.
  2. Type Corrections Queue Resolution as the Action heading.
  3. Assign the task to the Billing role.
  4. Select the patient's name using the Client drop-down menu.
  5. Select the case using the Case drop-down menu.
  6. In the Claims section, check the box for the denied date of service.
  7. In the Note section, please answer the following questions: 
    1. Why was the claim denied?
    2. What steps have you taken to resolve the issue? 
    3. In attempting to resolve the issue, did you call the payer? If so, please include the name of the representative you spoke with and the reference number for the call.
    4. Is the payer reprocessing the claim? If not, does the claim need to be resubmitted?
  8. Click OK to send the task to Clinicient's billing team.

When Clinicient's billing team receives the task, they will take the appropriate action to move the claim out of the Corrections Queue.

Note: If the task doesn't initially include all of the information needed to resolve the issue, the billing team may assign it back to you requesting clarification.

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