Write off with reason

Outcome

A denial that won't be paid (after appeal exhausted, or genuinely non- appealable) is written off with a reason your tenant can later report on, the receivable closes, and the audit trail is honest.

Prerequisites

Scope	What it lets you do
billing.denial.write	Write off
billing.payment.write	Apply contractual write-off entries (rare; usually inferred)

Some tenants gate write-offs behind a supervisor approval queue (PENDING_WRITEOFF). Check your tenant's policy.

The taxonomy

Each reason is a tag on the audit row; reporting groups by reason on the dashboard's Write-off causes widget.

Common reasons

Reason	When
contractual	The CO-45 already applied; balance is contractual. (Mostly automatic; rare manual write-off.)
timely-filing-expired	The window passed; appeal denied or not attempted with cause.
non-covered	Payer policy excludes; not appealable for your tenant.
auth-denied-final	Auth was denied at multiple levels; can't pursue further.
patient-uncollectable	Patient AR unpaid past collection threshold.
small-balance	Under tenant's small-balance threshold (commonly $5 or $10).
bad-debt	Sent to collections and returned.
other	Free-text reason required.

Steps

1. Open the denial. Click Write off.

2. Pick a reason from the picklist. For other, free text required.

3. Confirm the dollar amount. The platform pre-fills the denial's remaining balance; you can split (rare — for partial write-offs).

4. Submit. The denial:

   • Flips to WRITE_OFF (or PENDING_WRITEOFF if your tenant gates).
   • Writes a payment_application row of type WRITEOFF so the claim balance closes.
   • Generates an audit row with reason + actor.

5. (If gated): a supervisor approves at /denials?status=PENDING_WRITEOFF.

Bulk write-off

For genuine pattern write-offs (e.g. small-balance sweep at month-end):

1. Filter denials to the pattern (e.g. balance < 10 AND age > 90).

2. Bulk select, Mass write-off. One reason; applies to all selected.

3. Confirm. Per-row audit rows write; supervisor gate applies row by row.

Reversing a write-off

When a payer surprises you with a corrected 835 reversing the denial:

1. The platform auto-detects the CR reversal and flags the written-off denial.

2. Click Reopen. The write-off is reversed (audit logged), the denial returns to RESOLVED with the new payment, and the claim balance updates.

If the reversal didn't auto-detect, manually Reopen and post the incoming 835 against the original claim — the platform reconciles.

Validation

Check	Expected
Denial flips to WRITE_OFF (or PENDING_WRITEOFF)	Yes.
Claim balance closes	Yes.
Audit row carries reason + actor + amount	Yes.
Reopen reverses cleanly	Yes; balance returns.

Troubleshooting

Symptom	Cause	Fix
Write off greyed	Denial in APPEAL_PENDING (cannot write off pending appeal)	Withdraw appeal first, then write off.
Tenant requires reason category but you can't see one	Tenant config	Ask admin; sometimes the picklist is empty until configured.
Bulk write-off skipped some rows	Some rows are in protected states (APPEAL_PENDING, RESOLVED)	Summary tells you N/M; redo on the residue manually.
Auto-reopen didn't fire	CR reference didn't match	Manual Reopen + post; ping support.

Where to next

• 5.7 — Force-retry & overrides — when you need to bypass safety rails.
• 7.4 — Write-offs vs adjustments — when the right move is a patient-side write-off.