At a Glance

The Denials Worklist page is designed to point you directly at the most impactful denials to work, helping you maximize revenue collection for your practice.

Best Practices

1. Check the Denials Worklist daily. New remittances come in all the time, along with new denials that require your team’s expertise.

2. When you’ve corrected a claim in your EHR, mark it as ‘Updated in EHR!’ This signals Athelas to grab the updated claim info and resubmit.

3. Click into individual claims to review the notes left by the Athelas Denials Team. Often these will tell you exactly what action is needed.

4. Periodically, someone on your team should review the ‘Not Workable’ category to either write these denials off, or take one last shot at correcting them.

Full Features Overview

The Denials Worklist page displays claims that require action. Any claim that has already been resolved (from resubmissions to write-offs) is excluded by default in order to provide a clear line of sight on the most impactful claims to work.

However, although your worked claims are hidden by default, they’re always just one click away in the Worklist Settings.

Header Tabs

The top of the Denials Worklist page displays three tabs:

• Site Action Required

  Denials in this category will be your top priority. Your practice is responsible for making necessary updates in your EHR and then marking claims as ‘Updated in EHR’ (see example walkthrough below for directions). Once the correct updates have been made, these claims will be resubmitted automatically within 24 hours.

  💡 You’ll also notice these filters on the Site Responsibility tab:

  
  

  

  • Not Started

    These are denials on which no action has been taken.

  • Awaiting EHR Updates

    These are claims where your staff has indicated that corrections have been made in the EHR. Once our importers have pulled in the corrections, these claims will automatically be resubmitted, and will disappear from the denials dashboard.

  • Blocked

    Claims enter this status when a member of your team indicates that they need assistance from Athelas to resolve the claim. If you’re stuck and need help, mark the claim as Blocked.

  
  

• Athelas Responsibility

  Denials in this category will be worked and resubmitted by Athelas. No action is required on your part.

• Not Workable

  Denials are listed as ‘Not Workable’ if there are no available actions that will lead to approval (generally, things like duplicate claims and those that are too old to meet timely filing requirements end up here). Your practice should review and then write off these claims.

General Filters and Settings

The next items on the page are the General and Denial Detail filters, as well as the Worklist Settings. Use these to narrow your search and pinpoint the denials you want to view.

• General

  
  

  

  The Insurance Priority filter (in which you can specify Primary, Secondary, or Tertiary) is always active by default. You can add the following filters to your search as well:

  • Service Date Range

  • Latest Submission Date

  • Latest Date Posted

  • Facility

  • Provider

  • Patient

  • Billing Type

• Denial Detail

  
  

  

  By default, the Denial Type filter is active, and you can switch between Full or Partial Denial. You also have the option to filter your list by Reason, CARC, and/or RARC.

  Toggling on the ‘Denials with Notes’ will display only denials for claims on which someone has written a note.

  The ‘Your tagged Denials’ toggle will display only denials on which someone tagged your username in a note.

• Worklist Settings

  
  

  

  Using the Worklist Settings, you can add any resolved denial type back into the mix. Your options include:

  • Decision Pending, Encounter Finalized, Unposted Remittances, Inconclusive Remittances, Missing Recon, Overposted Encounters, Voided Denials, Capitation Denials, Appeals Filed, Medical Records Sent, and Reprocessing claims.

  Each of these settings also includes an explanation of exactly why this denial type is excluded from the Denials Worklist (and how Athelas is addressing them, if need be).

  
  

  

• Denials by Month

  This section allows you to see monthly denials data at a glance. It also acts as a monthly filter—simply click on a month so that the list below displays only that month’s denials, and click the month once more to revert.

  
  

  

Denial Reason Clusters

The dashboard is designed around a central organizing principle: solving one issue should resolve multiple claims.

We use two types of codes provided by the payer to identify denial causes:

• Claim Adjustment Reason Codes (CARCS)

  These describe the main cause of the Denial. Some of these are sufficiently vague that additional detail is needed, which is why we also get…

• Remittance Advice Reason Codes (RARCS)

  These optional codes provide a greater level of specificity that helps identify the root cause of the denial.

The dashboard groups your claims into CARC/RARC clusters, unifying all the claims with similar denial reasons so you can review them together.

View the Notes for Clues!

While you’re viewing an individual claim, be sure to check any related notes left by either your coworkers or Athelas staff. These notes often describe the action required and/or the reason a member of your staff is needed to resubmit the claim.

🔁 Example Walkthrough: Working Denials for Resubmission

Let’s look at this group of denials as an example case:

These eight claims were all denied due to the CARC CO-197, indicating that they were missing prior authorization upon submission.

💡The solution:

1. Update their prior authorizations individually

2. Mark them as Updated in EHR in bulk

1. Update Prior Authorizations

The first move to make here would be to update prior auth in your EHR. That way, Athelas can pull that information directly within 24 hours, ensuring no discrepancies between Athelas and your EHR.

However, if you want to resubmit sooner than that, you can update prior auth manually in Insights as well.

There are two primary ways to update prior auth in Insights:

• From the Patient Profile

  Visit the patient’s profile and click into the ‘Prior Authorizations’ tab. From here, you can either update an existing entry or create a new one.

  
  

  

• From the Encounter Details page

  First, locate and open the target encounter.

  You can add prior authorizations in the ‘Service Lines’ section in the encounter creation modal. Click Add Authorization(Fig. 1).

  Click Create and fill in the required information. Be sure to click Save when you’re done (Fig. 2).

  
  

  Fig. 1

  
  

  

  Fig. 2

  

2. Mark as ‘Updated in EHR’

Once you’ve made the necessary updates, you can mark all claims in this group as Updated in EHR in bulk.

First, select all updated claims. Then, open the ‘Actions’ menu and select Updated in EHR.

All claims marked as updated in EHR will automatically move into the Athelas Responsibility tab for automatic resubmission within 24 hours.

Tracking Your Progress

As you work denials, you’ll most often take one of three actions:

• Update in EHR

  Because Athelas treats your EHR as the source of truth, all you need to do to trigger a denial resubmission is to update the claim in your EHR. We’ll automatically import the corrected data overnight to resubmit the claim.

  • This will be your most common way of working denials!

  • Once you’ve made a correction in your EHR, mark the denial as “Updated in EHR”

• Mark as Blocked

  If you’re stuck and cannot determine the solution for a Denial with Missing Info, you can mark that claim as Blocked to request Athelas’ assistance.

• Write Off

  Inevitably, some denials simply cannot be fixed. You’ll need to write these off.

To mark denials as Updated in EHR or Blocked:

Select target claims. Then open the ‘Actions’ menu and select Updated in EHR or Blocked.

To write off denials:

Click into an individual claim and open the ‘Actions’ menu, then choose Write Off.

💡Viewing Denials from the Claim Details page

Because many people also use the Claims Details page to analyze denials, there’s a filter to let you see any denials visible in the Denials Worklist:

This is slightly different from filtering to the Encounter Status of Denied, which includes denials that have been worked and omits partial and secondary denials.

There is an explanatory alert to help clarify the distinction between the two:

General Feature Sets

Features Supported:

• High level metrics displaying denials health

• View denials broken down by month and denial reasons

• View denials broken down by owner (Site vs Athelas)

• Mark denial with tag indicating its status and owner

• Download denials csv

• Bulk resubmit

• Bulk push to next payer

• Bulk push to PR

• Request appeal

• 10+ filters to customize which denials you see

Features Not Supported:

• Show info around timely filing

• See/work all denials at once

In Conclusion

Using the Denials Worklist page effectively will help you prioritize the most actionable denials, giving you the best shot at reclaiming lost revenue for your practice.