This Bulletin should be shared with any staff using the MEDIK DENIAL and AUTHORIZATIONS NEEDING REVIEW reports.
Denial Report Changes have been made.
Claims will drop off the DENIAL and AUTHORIZATIONS NEEDING REVIEW reports if the claim containing all or part of the denied days has been advanced to a payor not on the Utilization Screen.
The Denial report is found under REPORTS>UTILIZATION REVIEW>DENIAL as shown to the left.
As you can see, there are new check box options. The new options are toggles that permit the user to:
- INCLUDE AUTHORIZATIONS WITH ZERO BALANCE
- INCLUDE AUTHORIZATIONS WITH EXHAUSTED APPEAL
This is just another way of filtering what claims the user may want to exclude. Denied claims may, or may not have a balance and this may be different than the admission balance. If the users don’t want to filter based on these options, do not check the box. There is also a new column on the report showing the CLAIM BALANCE (column AD). The ADMIT BALANCE (column AC) has always been on the report and prints the ADMIT BALANCE.
The major change in the DENIAL and AUTHORIZATIONS NEEDING REVIEW reports is if the authorization span on the Authorization screen is for a payor, and the claim has been advanced off that payor to another, the account will drop off these reports.
For example: acct# 000001-1 has an authorization for payor 500 from 1/1/14-1/10/14 and this authorization is denied. The user has advanced to Private Pay so they can write it off or transferred it to a Bad Debt ledger; once the acct is transferred and billed, the claim with the dates of 1/1/14-1/10/14 will no longer print on the denied report.