CBCS Education & Occupational Skills Learning Path • Module 5
Remittance, Payment Posting, Denials, and Appeals
Interpret adjudication results, post payments accurately, and route denials through a timely evidence-based follow-up process.
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Learning outcomes
- Connect remittance information to payment and adjustment posting.
- Classify denial causes before selecting a response.
- Prepare a timely, supported correction or appeal.
Post what the remittance supports
Remittance information explains how the payer processed the claim, including payment, adjustment, patient responsibility, or denial information. Posting should follow the remittance, contract terms, organizational policy, and balancing controls. Unexplained differences require investigation rather than forced adjustment.
Key points
- Match the payment to the correct account and service.
- Review adjustment and reason information.
- Balance totals and route exceptions.
Respond to the denial reason
Denial management begins by identifying the exact reason and whether the issue is registration, eligibility, authorization, documentation, coding, timely filing, coverage, duplication, coordination of benefits, or another category. Correctable claims may be resubmitted; disputed adjudications may require reconsideration or appeal under current payer rules.
Key points
- Do not appeal before understanding the reason.
- Track deadlines and required supporting evidence.
- Use denial trends to improve upstream processes.
Applied scenario
A denied claim with a deadline
A remittance shows no payment and identifies a denial reason. The appeal deadline is approaching, but the account note does not identify whether supporting documentation was previously submitted.
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