Overview
If an appeal's original denial has been upheld by a payer and it is determined that you cannot take any further action on the claim, the claim can be completed in OneSpot. Completing the claim will change the claim status and the appeal status.
Uphold Appeal - Complete Claim
1. To begin, access the previously appealed claim in OneSpot (Aging>Claims>By Claim Status>Under Appeal). Then, select the applicable claim to open its 'Claims Details' and view the 'Appeals' tab.
2. Select the three dots to the left of the appeal.
3. Select 'Uphold Appeal.'
4. 'Upheld Date' will default to the current date, if needed this can be edited.
5. Enter a comment. This could include the payer's reason for upholding the original denial.
6. Select 'Complete Claim.' Then, from the drop-down menu, select a reason for completing the claim.
7. When finished, select ‘Complete Claim.’ If you do not want to save the information, select ‘Cancel.’
The claim status will be updated to ‘Completed.’ The 'Appeals' tab within the claim details will update the status of the appeal to 'Upheld' and the ‘Activity’ tab will be updated as well.