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Claim reads "Denied" but the payer is saying it went to the client's deductible

Claim reads "Denied" but the payer is saying it went to the client's deductible

Payers may send incorrect data in a payment report which results in updating the status of the claim to Denied, rather than Deductible. In this guide we'll cover: 


Why payers sometimes send the Denied status on Deductible claims

Why payers sometimes send the Denied status on Deductible claims

If you're enrolled to receive payment reports and a claim comes back as Denied, please note this information is sent to us directly by the payer. 

Occasionally, payers will send a Denied status by default if they aren't issuing a payment to the provider. In the case of claims going toward a client's deductible, the payment report doesn't include a payment made to the provider so the payer may indicate that it's Denied, rather than sending the usual Deductible status. 

In these cases, the insurance payers aren't sending the correct language in the patient responsibility portion of the payment report data we receive. Please keep in mind that this is an issue on the payer's end but you'll have two options for resolving this scenario. 

When viewing a client's Billing page, all Denied claims will have a red triangle highlighting that the claim hasn't been resolved yet. This serves as a reminder that the claim still needs to be addressed. 


Marking Denied claims as Resolved

If you've confirmed that the claim wasn't denied and instead went toward the client's deductible, you can choose to mark it as resolved by following these steps: 

  • Navigate to the client's Billing page
  • Hover over the denied claim in question and select Mark as Resolved:

markasresolved.simplepractice.denied.png

Keep in mind that this option will remove the denial notification from the client's Billing page, but the claim status won't change and their insurance balance won't be cleared. If you'd like to remove the Denied status to avoid any confusion in your financial reports, we recommend following the steps below to mark denied claims as paid. 


Marking Denied claims as Paid

There isn't a way to change a claim's status to Deductible, but you can update it to Paid to indicate that the date of service has been resolved and paid by the client. While a Paid status isn't as accurate as Deductible in this scenario, Paid still represents a finalized status that requires no further action. 

This option can be beneficial when running end of year Insurance reports. A Filed Claims report, for example, shows all claim statuses within a given period. You can choose to update a claim that was incorrectly labeled as Denied to Paid once it's been addressed so that it doesn't appear to need correcting in a Filed Claims report. 

Note: See our guide on analytics for your private practice for more information on the types of reports you can run in SimplePractice. 

To update a Denied claim to Paid: 

  • Go to your client's Billing page
  • Click Add Insurance Payment
  • Enter 0 in the Amount and Insurance Paid fields
  • Update the Client Owes amount that you wish to charge the client and click the refresh icon to calculate the write-off:

payment.simplepractice.deductible.png

  • Click Save Payment

Tip: For the claim to update to Paid, the sum of the Client Responsibility, Insurance Paid, and Write-Off amounts must equal the total appointment fee.

See our guides on entering an insurance payment and how to bill a client who hasn't met their deductible for further guidance on each respective scenario. 

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