Match each denial-management situation with its solution. A decision about the next action must be made. The options are to bill the patient, write off the amount, or challenge the determination with an appeal. Some provider contracts prohibit billing the patient if an appeal or necessary documentation has not been submitted to the payer. Rejected claim If a procedure that should have been paid on a claim was overlooked, another claim is sent for that procedure. Procedure not paid If the payer has denied payment, the first step is to study the adjustment codes to determine why. If a procedure is not a covered benefit or if the patient was not eligible for that benefit, typically the next step will be to bill the patient for the noncovered amount. Partially paid claim A claim that is not paid due to incorrect information must be corrected and sent to the payer according to its procedures. Denied or downcoded claim Reset