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Be the King or Queen of Denials – Denials Management in MEDITECH 6.0 Debbie Meredith. Introduction. Today we’ll talk about how to set up the Denial Management Dictionary
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Denials Management in MEDITECH 6.0
How many of you are struggling with Denial Management in your current environment?
Use the Remit Reason Dictionary routine to define the explanation or cause of a remittance advice code. One denial department can be defined for each Remit Reason entry.
For example, define an entry called ABS CODE to classify remittance codes related to coding errors that caused a charge to be rejected by the payer. In this case, create a Denial Department called ABS that will be responsible for resolving coding errors.
Use the Remittance Advice Code Dictionary to define remittance advice codes. Remittance advice codes from insurance companies or intermediaries help health care organizations manage insurance companies' responses to their claim submissions.
The General screen allows you define the mnemonic for the remittance advice code, and the insurance carriers associated with that code
Use this screen of the Remittance Advice Code Dictionary to define a schedule of effective dates for remittance advice codes.
For every effective date that is specified (usually the date when codes are updated), a multiple code type can be assigned. One or more remittance advice codes can be further associated to a code type.
Define each individual remittance advice code with the following information:
Whether to send code to the ABS application
Where to transfer leftover amount (for line-item remittance only)
Letter to be queued
Each time an effective date is added, the system adds the new date below the last effective date in the lookup.
Fatal, Non-Fatal, and Informational remittance advice codes appear on the denial user's worklist.
No Action remittance advice codes do not appear on a worklist, but any remittance codes with the same UCRN will appear on the RA Code Data screen, and the Denial User can see No Action codes for that same UCRN on that screen.
Adding Remit Reason value to a remittance advice code allows you to track the denial departments responsible for processing that denial.
Use this screen of the Remittance Advice Code Dictionary to define criteria in which specific users are responsible for specific remittance advice codes.
Assign remittance advice codes to users in the following manner:
assign denial codes based on a range of insurance carriers
assign denial codes based on effective date/code type/code combinations
assign default users, in case other settings on this screen are not applicable
If all of the denial codes to go to one person, only define the default user on this screen and leave the rest of the fields on this screen blank.
NOTE: This screen does allow for greater specificity to the user settings. The only options of assigning users is by an effective date/code type/code schedule or by insurance.
Sequence of Evaluating Criteria for Remittance Code Assignments
The three sections on the Users screen also represent the hierarchy of values that the system uses when assigning denial codes to users.
Since the bottom section contains very specific criteria, the system uses the bottom section first, then the insurance criteria on the middle section, then the most general criteria on the top section.
When a batch with remittance advice codes is posted, the system looks at the effective date of the remittance code as the first step.
The effective date is based on the code's transaction service date from the batch.
If neither the first criteria nor second criteria does not apply, the user in the Default User field will be assigned the denial codes.