Denial Management

This page will detail the process behind creating a denied claim and how to resubmit from TRAKnet 3.1.

Creating a Denied Claim

When downloading a remit TRAKnet will automatically review each CPT code to verify if a payment was made. If a payment was not made TRAKnet will then verify if their is a PR-1 Adjustment Code attached. If there is a PR-1 Adjustment Code TRAKnet will not mark this as a denied code (yet). If there is no PR-1 adjustment code TRAKnet will then verify if the payer has already paid a balance on this CPT, if the payer has the CPT will be flagged as paid, if we only show $0.00 paid for this line the claim will be send to the denial module.

Sending a Denial

After correcting your denied claim, you must send these denied claim(s) from TRAKnet to Availity, where they will then be forwarded on to the insurance company. Claims are sent from the Billing Dashboard of TRAKnet 3.1 under the "Denial Claims" screen.

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The Denial Queue

After a denied claim has been marked "denied," that claim will appear in the denial claims queue. When in the denial claims screen under the Billing Dashboard, you will notice two views. These are:

  • Denial Pending - Unsent — This view will display all denial claims that are ready to be worked, and have no resubmission history.
  • Denial Sent — This view displays all denial claims that have been successfully sent. It will show the date sent, the note date, patient information, balance information, insurance, the method of how it was sent, who sent it, what the batch number was, and which computer the claims were sent from.
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Sorting the Denial Claims Queue

The Denial Pending - Unsent view is the view that will primarily be used when working/sending out a denial claim batch. On this view, there are several filtering and sorting options that will allow the user to see only certain claims.

Claims can be sorted by:

  • Date Range, based on Note Date
  • Sequence, such as Primary, Secondary, or Tertiary
  • Output, such as paper, electronic, or none
  • Positive Balances Only

You can select all items in the denied claims queue based on their output with the "Select" drop-down menu and the related criteria.

Sending Denied Claims

Send (Resubmit Claim)

  • When sending a denied claim you will have two options:

To send denied claims, simply check the box next to the denied claim you wish to send and click Send. These denied claims will be placed in one denied claims batch file before being sent to Availity to be forwarded to the payers.

Send Secondary/PR-RSP

  • The Send Secondary/PR-RSP button is designed to skip over resubmitting the claim. When selecting this option TRAKnet will build a secondary claim to submit to Availity or if the encounter/patient does not have a secondary insurance TRAKnet will mark the claim as patient responsible for you.

After sending denied claims, we recommend clicking the Availity icon to navigate to your Availity website portal and then clicking the Confirm File Delivery option to ensure your denied claim file is received. Please wait 5-10 minutes for this to process.

Insurance Settings

With denied claims we have created a new dropdown under every insurance company. This Dropdown will be updated as insurances make modifications to their requirements.

Current Denial Claim Settings:

  • Send Only Denied CPT Codes? - When set to "True" TRAKnet will only submit codes that were denied. "False" will simply submit all CPT codes.
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