Managing Denials and Claim Corrections

To simplify the management of denials and corrections, we've included tabs specifically for your practice on your payout receipt. This article explains the purpose of each tab, required actions, and best practices to ensure timely resolution.

Tab Descriptions & Instructions

Denials Tab

• Purpose: Displays only those denials that require action from you, such as submitting missing documentation or answering inquiries.

• Action Required:

  • Check every Thursday for new requests

  • Fill out the Corrections and Medical Record Submission form

  • Upload all required documents (e.g., medical records, authorization letters) and correctly associate them with the appropriate Denial ID

• Use the following file naming convention:

  • Denial ID_Description

  • Example: 123456_LabResults.pdf

• Submission Deadline: Upload documents within seven calendar days of the request to avoid delays.

Corrections Tab

• Purpose: Displays claims requiring correction, such as coding updates, billing errors, or resubmissions based on payer feedback.

• Action Required:

  • Check the Corrections tab every Thursday for new claims needing updates.

  • Fill out the Corrections and Medical Record Submission form

  • Upload supporting documentation if needed 

  • Use the following file naming convention:

    • Claim ID_CorrectionType

    • Example: 987654_CodingCorrection.pdf

  • Submission Deadline: Upload corrections within seven calendar days of the request to prevent further claim delays.

Notifications & Follow-up

• Our team receives an automated notification whenever you upload a document via the Corrections and Medical Record Submission form, ensuring prompt visibility.

• Submitted forms are reviewed in priority order based on payer timelines and urgency.

• If additional information is needed, updates will be added to the appropriate tab with the same corresponding ID.

• Once processed, claims and denials will be updated according to their outcome.

Common Denial & Claim Scenarios

Scenario 1: Denial Resubmitted to the Payer

• What happens?

  • A new Claim ID will appear in the Claim Tab once the denial has been resubmitted to the payer.

  • The Denial Tab will be updated to reflect that the denial has been addressed and the status will be closed.

• How to Track?

  • Locate your new Claim ID in the Claim Tab to track its progress.

  • The claim will follow the standard processing timeline, and any updates will be reflected directly in the Claim Tab.

Scenario 2: Claim Corrected and Submitted to Payer

• What Happens?

  • If a claim correction is successfully submitted to the payer, it will disappear from the Corrections Tab. The updated Claim ID will appear in the Claim Tab for continued tracking.

• How to Track?

  • Check the Claim Tab for the new Claim ID and follow the status updates directly from there.