Denial Analytics Data Dictionary

Values

In Microsoft Excel, ‘Values’ are the actual numbers that you are able to analyze/report on.  This type of data is quantitative (numerical). You will see the possible values at the top of the PivotTable Fields list as follows.

Here are the available values: 

• Adjustments: The dollar amount that was posted as adjustments against the claim line's balance. 
• Comments: The dollar amount that was posted as a comment on the line only. 
• Count: The number of qualifying CARC/RARC lines. 
• Payments: The dollar amount that was posted as an actual payment. 
• Total Amount: The total amount of the CARC code, including Adjustment amounts, Comment amounts, and Payment amounts.

Additional Fields

The other available fields are how you might analyze or break down a number. This type of data is qualitative, grouping and dividing values out into categories. All non-date fields are grouped into folders by category. 

• Deposit Date Y-M-D: This allows a user to filter or group CARCs received based on their deposit dates. This deposit date is entered on the deposit itself. 
  • Deposit Year: The year value of the associated deposit's deposit date. 
  • Deposit Month Name: The month name of the associated deposit's deposit date.
  • Deposit Day: The day of the associated deposit's deposit date.
• Disbursed Date Y-M-D: This allows a user to filter or group CARCs received based on the disbursement date of the deposit. This is the date the associated deposit was fully disbursed, the date that the last outstanding deposit claim was finally posted. 
  • Disbursed Year: The year value of the associated deposit's disbursement date. 
  • Disbursed Month Name: The month name of the associated deposit's disbursement date.
  • Disbursed Day: The day of the associated deposit's disbursement date.
• Post Date Y-M-D: This allows a user to filter or group transactions based on when the deposit claim associated with the CARC code was posted. 
  • Post Year: The year value of the associated deposit claim's post date. 
  • Post Month Name: The month name of the associated deposit claim's post date.
  • Post Day: The day of the associated deposit claim's post date.
• Service Date Y-M-D: This allows a user to filter or group CARC codes based on the associated service dates. Please note that this is a good way to see all denials received for a certain service date range, but the denial amounts shouldn't necessarily be compared to charges or outstanding receivables for a certain range. This is due to the fact that you can receive multiple denials for a given charge, and this report shows posted CARCs regardless of the current state of the resulting payments. 
  • Service Year: The year value of the associated claim's service date. 
  • Service Month Name: The month name of the associated claim's service date. 
  • Service Day: The day of the associated claim's service date.
• Alternate Provider: Fields related to the alternate provider on the claim. 
  • Alternate Provider Reverse Name: The claim alternate provider’s name in the format “[Last Name], [First Name]”.
• Attending Provider: Fields related to the attending provider on the claim. 
  • Attending Provider Reverse Name: The claim attending provider’s name in the format “[Last Name], [First Name]”.
• Claim Information: General information regarding the claim the CARCs are posted to.  
  • Claim ID: The unique ID for the claim.
  • Claim Level: The current level of the claim—set to Primary, Secondary, Tertiary, Statement, or Completed. 
  • Claim Status: The current Claim Status. 
  • Claim Submission Type: The current Submission type for the claim, Electronic or Paper. 
  • Claim Substatus: The text description for the current Claim Substatus.
  • Claim Type: The current Claim Type (Medical, Dental, EPSDT, DME, etc.) on the associated claim. Note: Medical is the default Claim Type on all claims.
• Claim Primary Payer: The primary payer assigned to the relevant claim. 
  • Claim Primary Financial Class: The financial class of the claim’s primary payer. 
  • Claim Primary Payer Name: The name of the claim’s primary payer. 
• Claim Secondary Payer: The secondary payer assigned to the relevant claim.
  • Claim Secondary Financial Class: The financial class of the claim’s secondary payer. 
  • Claim Secondary Payer Name: The name of the claim’s secondary payer. 
• Claim Tertiary Payer: The tertiary payer assigned to the relevant claim.
  • Claim Tertiary Financial Class: The financial class of the claim’s tertiary payer. 
  • Claim Tertiary Payer Name: The name of the claim’s tertiary payer. 
• Date Fields: Additional date fields available if needed to add in any of the field sections of the report. 
  • Deposit Date: The associated deposit's full deposit date.
  • Deposit Month Name: The month name of the associated deposit's deposit date.
  • Deposit Year: The year value of the associated deposit's deposit date.
    
  • Disbursed Date: The associated deposit's full disbursement date.
  • Disbursed Month Name: The month name of the associated deposit's disbursement date.
  • Disbursed Year: The year value of the associated deposit's disbursement date.
  • Post Date: The associated deposit claim's full post date. 
  • Post Month Name: The month name of the associated deposit claim's post date.
  • Post Year: The year value of the associated deposit claim's post date.
  • Service Date: The associated claim's full service date.
  • Service Month Name: The month name of the associated claim's service date.
  • Service Year: The year value of the associated claim's service date.
• Deposit Claim Information: Posting information related to the Deposit Claim.  
  • Posting Claim Level: The posting Claim Level from the Deposit Claim.
    
  • Posting Claim Status: The posting Claim Status from the Deposit Claim. 
  • Posting Remit Status: The remit status from the Deposit Claim.
• Deposit Information: Fields related to the CARCs' originating deposit.   
  • Create User: The user who created the associated deposit.
    
  • Deposit ID: The Deposit ID for the associated deposit. 
  • Deposit is Posted: Shows whether the deposit has been sent to posting. 
  • Deposit Model: The model type of a given deposit (Standard, Converted, or Legacy). 
  • Deposit Type: The type of the deposit (EOB, ERA, Import, or Statement).
  • Statement ID: The statement ID associated with the deposit. 
• Deposit Payer: Fields related to the payer on the deposit. 
  • Deposit Payer Financial Class: The financial class for the payer on the deposit.
    
  • Deposit Payer Name: The name of the payer on the deposit. 
• Location: Fields related to location, whether patient location, service location, or business unit. 
  • Business Unit: The business unit allocation for the claim.
    
  • Patient Location: The Patient Location currently on the claim.
  • Service Location: The Service Location currently on the claim.
• Ordering Provider: Fields related to the ordering provider on the claim.
  • Ordering Provider Reverse Name: The ordering provider’s name in the format “[Last Name], [First Name]”. 
• Patient Address: The fields that comprise the address of the patient on the claim. 
  • Patient Address 1: Line 1 of the patient’s address. 
  • Patient Address 2: Line 2 of the patient’s address.
  • Patient City: The patient’s city. 
  • Patient State: The patient’s state. 
  • Patient Zip: The patient’s zip code. .
• Patient Demographics: Information relevant to the patient on the claim. 
  • Patient DOB: The patient’s date of birth. 
  • Patient Email: The patient’s email address. 
  • Patient Gender: The patient’s gender.
  • Patient ID: The patient's chart number. 
  • Patient is Active: ‘1’ if the patient is active, ‘0’ if the patient has been made inactive. 
  • Patient is Living: ‘1’ if the patient is living, ‘0’ if the patient is deceased. 
  • Patient Reverse Name: The patient’s name in the format “[Last Name], [First Name]”.
• Payment Information: Information relevant to the payment resulting from the CARC code. 
  • Payment Type: The payment type assigned to the payment upon posting. 
  • Payment Type ID: The payment type ID assigned to the payment upon posting. 
  • Posting Type: Denotes whether this CARC was posted as a payment, an adjustment, or a comment. 
• Procedure: Information related to the procedure code that the CARC was posted on.  
  • Code: The procedure code on the claim line. 
  • Code Modifiers: The description of the procedure code on the claim line, truncated to 30 characters.
  • Code with Desc: The full description of the procedure code on the claim line. 
  • CPT Group: The Code Group for the procedure code on the claim line. 
  • Diagnoses: The full diagnosis list for the procedure code on the claim line. 
  • Primary Dx with Desc: Shows both the primary diagnosis code on the claim line and its short description.
• Reason Codes: Information related to the CARC/RARC codes that were posted.  
  • CARC: The individual CARC code that was posted. 
  • CARC is Denial: 'Y' if the CARC code is marked as a denial. Otherwise, set to 'N'.
  • CARC with Description: The posted CARC code with its description.
  • RARC: The RARC codes that were posted. 
  • RARC with Description: The posted RARC codes with their descriptions. 
• Referring Provider: The referring provider on the claim.
  • Referring Provider Reverse Name: The referring provider’s name in the format “[Last Name], [First Name]”. 
• Rendering Provider: The rendering provider on the claim.
  • Rendering Provider Reverse Name: The rendering provider’s name in the format “[Last Name], [First Name]”.
• Supervising Provider: The supervising provider on the claim.
  • Supervising Provider Reverse Name: The supervising provider’s name in the format “[Last Name], [First Name]”.