The ERA 835 Denial report provides information about ERA 835 autopayments that are denied or partially paid for a time range of up to one month. This report allows the office to identify and fix issues with their ERA 835 claims. In order to access this feature, the office should send a request to the support team or your account manager to enable the ERA 835 Denial Report.
To access the report:
- Go to Reports>Insurance Reports
- Select the option for "835 Denial Report"
- Select to run for "Summary" or "Detail"
- Select to print to PDF or Excel
- Set Date Range
- Select Carriers to include on report
835 Denial Report-Summary:
835 Denial Report-Summary Fields:
- Carrier: Also knows as Payer
- Charges Submitted (Amount): Dollar amount the office submitted to the insurance company for a given procedure.
- Other Adjustment (Amount): Used when there is no contractual obligation or patient responsibility on the claim.
- Contract Obligations (Amount): The amount between what office billed and the amount allowed by the payer when in-network with the office. This is the amount that the provider is contractually obligated to adjust from the claim.
- Patient Responsibility (Amount): Used to identify portions of the bill that are the responsibility of the patient. These could include deductibles, copays, coinsurance amounts along with certain denials. If the patient did not have coverage on the date of service, you will also see this code.
- Actual Allowed (Amount): This is also referred to as the maximum plan allowance or maximum allowable charge. Dentists have agreed to accept a maximum plan allowance based on the agreements they have signed with the carrier. This does not apply to non-participating dentists.
- Paid Amount: The amount paid by the carrier to the dentist for a submitted claim.
835 Denial Report-Detail:
835 Denial Report-Detail Fields:
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Carrier: Also known as Payer
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Service Code: Code for the procedure
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Reason Code (Patient Responsibility): Code for the adjustment or denial reason (by procedure)
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Aligns w/ Patient Responsibility, Contract Obligations, Other Adjustment
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Reason Code Description: Description for the adjustment or denial reason
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Count (Reason Code): Total number of reason codes (by service)
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Charges Submitted (Amount): Dollar amount the office submitted to the carrier for a given procedure.
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Other Adjustment (Amount): Used when there is no contractual obligation or patient responsibility on the claim.
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Contract Obligations (Amount): The amount between what office billed and the amount allowed by the payer when office is in-network. This is the amount that the provider is contractually obligated to adjust from the claim.
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Patient Responsibility (Amount): Used to identify portions of the bill that are the responsibility of the patient. These could include deductibles, copays, coinsurance amounts along with certain denials. If the patient did not have coverage on the date of service, you will also see this code.
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Actual Allowed (Amount): This is also referred to as the maximum plan allowance or maximum allowable charge. Dentists have agreed to accept a maximum plan allowance based on the agreements they have signed with the carrier. This does not apply to non-participating dentists.
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Paid Amount: The amount paid by the carrier to the dentist for a submitted claim.
835 Denial Report-Detail-Excel:
835 Denial Report-Detail-Excel Fields
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Office Name: Dental office name
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Carrier Name: Also known as Payer
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Carrier ID: The carrier identifier
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Patient ID: Patient identifier
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Claim ID: Claim identifier
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DOS (Date of Service): Date of the procedure
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Service Code: Procedure code
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Charges Submitted (Amount): Dollar amount the office submitted to insurance company for a given procedure.
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Reason Code: Code that identifies the reason that the adjustment is the responsibility of the patient.
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Reason Code Description: Description that identifies the reason that the adjustment is the responsibility of the patient.
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CO Reason Code: Code that identifies the reason the adjustment is a contractual obligation (CO) between the provider and the carrier.
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CO Reason Code Description: Code that identifies the reason the adjustment is a contractual obligation (CO) between the provider and the carrier.
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Other Reason Code: Code that identifies the reason for the adjustment when it does not fall under contractual obligation or patient responsibility.
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Other Reason Code Description: Description that identifies the reason for the adjustment when it does not fall under contractual obligation or patient responsibility.
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Remark Code: Code to provide additional information about claim adjustments to providers and facilities.
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Remark Code Description: Code to provide additional information about claim adjustments to providers and facilities.
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Patient Adjustment (Amount): Used to identify portions of the bill that are the responsibility of the patient. These could include deductibles, copays, coinsurance amounts along with certain denials. If the patient did not have coverage on the date of service, you will also see this code.
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CO Adjustment (Amount): The amount between what the office billed and the amount allowed by the payer when in-network. This is the amount that the provider is contractually obligated to adjust from the claim. The patient is not responsible for this amount.
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Other Adjustment (Amount): Used when there is no contractual obligation or patient responsibility on the claim.
-
Actual Allowed (Amount): This is also referred to as the maximum plan allowance or maximum allowable charge. Dentists agree to accept a maximum plan allowance based on the agreements they have signed with the carrier. This does not apply to non-participating dentists.
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Paid Amount: The amount paid by the carrier to the dentist for a submitted claim.