Payers may send incorrect data in a Payment Report, resulting in the status of a claim updating to Denied, rather than Deductible. In this guide, we'll cover:
- Why payers sometimes send the Denied status on Deductible claims
- Marking Denied claims as Resolved
- Marking Denied claims as Paid
Why payers sometimes send the Denied status on Deductible claims
If you're enrolled to receive Payment Reports, the information that updates a claim’s status is sent to your account directly from 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, because the Payment Report doesn't include a payment amount, the payer may indicate that it's Denied, rather than sending the usual Deductible status.
Because this stems from how insurance payers send Payment Report data, we’re unable to update the claim status automatically. However, there are two options below for addressing this scenario.
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. To do this:
- Navigate to the client's Billing page
- Hover over the denied claim in question
- Select Mark as Resolved:
This option will remove the denial notification from the client's Billing page; however, the claim status will still show Denied, and their insurance balance won't be cleared.
Marking Denied claims as Paid
While there isn't a way to change a claim's status to Deductible, 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, Paid still represents a finalized status that requires no further action.
This option can be beneficial when running end of year Insurance reports. For example, a Filed claims report 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 the Filed claims report.
To update a Denied claim to Paid:
- Navigate 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
- Click the refresh icon to calculate the write-off:
- Click Save Payment
Tip: For a 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.