A downcoded claim is when a Payer pays for a lower-level, less complex, or less expensive service than what your practice submitted. This results in a lower reimbursement for the services you provided. The most common way to know about this decision is through your electronic remittances (ERAs).

Elation reviews ERAs and identifies certain claims that have been downcoded. This applies to any Evaluation and Management (E/M) CPT Code beginning with 992:

Follow the instructions below to locate downcoded claims.

Downcoded claims will be automatically tagged as Downcoded. These claims will appear on the Worklist, and you can use the Search bar to filter the Worklist by the Downcoded tag.

Click here for instructions on how to remove these claims from the Worklist.

On the Superbill page, an alert at the top of the page will notify you when a payer has downcoded a claim and what the resulting paid amount is.

On the Payment page, an alert will appear at the top to notify you when a payer has downcoded any claim. It will show you which claim was affected and the resulting paid amount.