How to Work ABA Claim Denials: Categories, Assignments and 5 Actions

Denials don't get worked because they arrive as lines on a remittance nobody has time to read. TargetFlo's Billing → Denials turns each one into a work item with an owner and a due date.

How a denial becomes a work item

When an ERA posts, every adjustment that isn't CO-45 or patient responsibility creates one work item per claim and reason code (more of the same code adds to the amount). It's due in 14 days.

8 categories, from the reason code

Category	Typical cause
Eligibility	Coverage ended or not active on the date
Authorization	Missing or expired prior authorization
Coding	Code, modifier, units or diagnosis problem
Duplicate	Claim or line already submitted
Timely filing	Sent after the payer's limit
Credentialing	Rendering provider not credentialed
Missing information	Data the payer needs is missing
Other	Anything not mapped

Assign and track

Assign items one by one or in bulk; assigning moves them to In progress. Filter by assignee and category and see open and closed counts per person.

5 actions

1. Correct — creates a linked corrected claim (frequency 7) to fix and resend.
2. Appealed — record the appeal; the item stays open until the payer answers.
3. Write off — with a required reason.
4. Close — resolved.
5. Reopen — back to in progress.

Prevent the next one

Most denials are preventable upstream: eligibility checks, authorization tracking, held charges and the claim scrubber.

Related: ABA revenue dashboard metrics · Billing & Claims