Claims
Denials management
A denial is recorded when a posted 835 says a payer refused a line, with the payer's reason code. Each denial ends in one of four decisions: correct and resubmit, appeal, move the balance to the patient, or write it off.
Written for: Billing and RCM teams · Revenue cycle leadership
Where denials come from
Only from posted 835 remittances - collected from the clearinghouse mailbox or uploaded on ERA/EOB Posting. There is no manual "record a denial" entry.
| Field or control | What it means |
|---|---|
| Line-level adjustments | Read from each service line (SVC with its CAS), not just the claim header, so a single denied line is caught. |
| Contractual reductions | Routine fee-schedule reductions such as CO-45 are not denials. They post as adjustments. Which reason codes count is the practice's write-off list (groups CO, PI or OA only), set on Settings → Remittance policy. |
| Patient responsibility (PR) | Never a denial. It is the patient's share and moves to the patient balance. |
| Everything else | A non-PR adjustment with any other reason code is recorded as a denial against its line, with the group code, reason code and description. |
The screens
| Field or control | What it means |
|---|---|
| Denials | ArkCloud RCM → Insurance → Denials The worklist of denied claims, with reopen for correction and transfer to patient. |
| Denial analytics | Insurance → Denials → Analytics. Denials grouped by reason and payer from the recorded denial rows. |
| Denial causes | /dashboard/claims/denial-causes. Traces each denial back through its charge, service, visit and note to the episode and authorization that produced it. Not in the sidebar - open it by address. |
Denial analytics, shown before any remittance has been posted. Populated from denial rows created by 835 posting.
Empty state. Captured in a demonstration organisation with no records of this type yet. The controls, columns and filters are the ones a populated screen uses.
/dashboard/insurance/denials/analytics
Working a denial
| Field or control | What it means |
|---|---|
| Correct and resubmit | Reopen for correction (administrators) returns the claim to Pending, then submit it as a replacement claim. See claim corrections. |
| Appeal | Record an appeal on the claim. ArkCloud tracks it; you send it to the payer. See appeals. |
| Transfer to patient | Administrators only. Moves the claim's open balance to patient responsibility and voids the claim. Only for claims built from charge lines. |
| Write off | Supervisor or Admin. On the denial's detail page, set its status to Written off: the denied amount is written off the charge and leaves A/R. |
| Bill a secondary payer | A denied primary with secondary coverage appears on Ready for secondary. |