Entering denial Reason Codes from
EOBs
When insurance payers deny a
TRX, they usually provide a denial reason, such as Ineligible patient, not
medially necessary, etc. These
denial codes can be linked to each TRX.
On the Payment posting
Screen, there is a column labeled RSN for reason
code.
Enter a number corresponding
to the denial codes listed below.
These denial codes are based on the standard codes issued by
Medicare. These dened codes will appear on patient
ledger.
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OIEOB *OPEN ITEM EOB ENTRY* Is
this (P)atient or (I)nsurance Pmt ?
I Svc:
Ins:
Running Total:
Enter Patient:
Dates: Amt:
Balance:
Adjusted:
Adjust: Pri:
Paid:
Deduct:
Due: Sec:
Paid:
Deduct:
Due: Pat:
Paid:
Deduct:
Due: 1.Date:
2.Chk #:
3.Note: 4.Allowed:
5.Deducted:
6.Paid:
7.Auto Adjust? (Y/N): Date Prc Cde Billed Balance Allowed Apply Deduct Copay
Adjust 1 2 3 4 5
Applied :
CHANGE WHICH # (0 FOR NONE, -1 TO
ABORT): |
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/u/zybex/cyber/run/denycode.seq |
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4 Modifier
inconsistent or missing 5 Place of service
inconsistent with service 6 Procedure
inconsistent with age or gender 9 Diagnosis
inconsistent with age or gender 11 Diagnosis inconsistent
with procedure 13 Date of death before
service 16 Claims lacks
information 17 Requested info not
received 18
Duplicate 19 Denied, work
related 20 Denied, covered by
another payer 24 Capitated services 26 Charges prior to
coverage 27 Charges after coverage
terminated 29 Timely
filing |
31 Unable to identify
patient 32 Not an eligible
dependent 39 Not
authorized 46 Not a covered
service 47 Not a covered
diagnosis 48 Routine or screening
services 50 Services not medically
necessary 52 Referring provider not
eligible 57 Frequency of
services 59 Multiple surgery
rules 96 Non-covered
charges 150 Level of service not
supported 315 Bundled
services 318 Procedure code invalid on
date of service 999 Misc. adjustment document in
notes |
CSR
Setup:
Programs needed:
Pgfkey.run 9.5(137) Sysfl5.scr
Field #11 must say “Y”
Oieob.run 9.5(145)
./run/denycode.seq
Edit denycode.seq to add more
codes.