The Kipu CRM Denial criteria encompass a range of reasons why a patient might be denied admission to a facility. These criteria include patient-related factors such as age inappropriateness, clinical issues (e.g., behavioral acuity, comorbid conditions, or seeking services not offered), and financial constraints (e.g., insufficient insurance benefits, outstanding balances). Other reasons involve logistical issues like lack of bed availability or facility capacity, legal restrictions, or the patient's personal choice not to pursue treatment.
Denial Criteria Options
| Denial Criteria Options | |||
|---|---|---|---|
| Administrative Denial | Adoption | Age, Inappropriate for Organization | Age, patient aging out |
| Bed Not Available Declines to be Waitlisted | Bed Not Available Patient Waitlisted | BMI too low | Client Is Under 18 Years Old |
| Client Resides Out Of State | Clinically, Behavioral Acuity | Clinically, Better Served At Higher Level Of Care | Clinically, Better Served At Lower Level Of Care |
| Clinically, Client Unsuccessful Previously with our Organization | Clinically, Co-Morbid Medical Condition Prohibit Placement | Clinically, Co-Morbid Psychiatric Condition Prohibit Placement | Clinically, Co-Occurring Disorders Prohibit Placement |
| Clinically, Could Not Obtain a Referral From PC | Clinically, Inappropriate per Admissions | Clinically, Inappropriate per Clinical Director | Clinically, Non-VFR |
| Clinically, Seeking Couples / Family Counseling | Clinically, Seeking Evaluation Services Only | Clinically, Seeking In-Person Treatment | Clinically, Seeking Medication Management Only |
| Clinically, Treatment Requested Not Offered By Our Organization | Clinically, Treatment requested/needed not offered by our organization | Could Not Obtain Consent | Couple Seeking Treatment Together |
| Currently Incarcerated | DCS Hold | Did Not Pay Intake Invoice | Did Not Return Pre-Admission Packet |
| Did Not Show Up For Intake Appointment | Evening IOP Not Available | Facility At Capacity, Waitlisted | Family Declined |
| Family declined/chose another program | Family Does Not Have a Minor Child in the Household | Family is Not Homeless | Family Never Reached Out - Unable to Contact |
| Financial, Insurance Case Manager Not Approved | Financial, UM Not Approved | Financially, Does Not Qualify For Gov't Programs | Financially, Does not Qualify for Scholarship |
| Financially, Insufficient Insurance Benefits | Financially, Insurance Coverage Terminating | Financially, Looking for Government Funded Program | Financially, Medicaid Patient |
| Financially, Medicare Patient | Financially, No Insurance Benefits | Financially, No OON Insurance Benefits | Financially, Out Of Medi-Cal Network |
| Financially, Outstanding Account Balance Prohibits Placement | Financially, Patient Aging Out | Financially, Prospect chose in-network facility | Financially, Unable To Leave State (Payor Restrictions) |
| Financially, Unable To Meet Anticipated Patient Responsibility | Financially, Unable To Secure Loan | Hospital Provider Refused To Transfer | Incompatible Gender |
| Individual Chose Alternative Level Of Care | Individual Chose to Go Elsewhere for Treatment | Individual Chose to Not Admit | Individual Not Interested In Services At This Time |
| Individual Refused Any Treatment | Infant Medical Issue | Insufficient Ins. Rates | Insurance Auth Denied |
| Insurance Pre-Auth Denied | Lack of motivation / Not ready for treatment | Legal, Unable To Leave State | Looking for District/IEP funded program |
| Medically Inappropriate | Mental Health Only | Methadone PX too high | Miscarriage |
| Mother Medical Issue | Needs to engage with local DAT | No Response To Intake Scheduling | Organization unable to support prospects special needs |
| Potential client unaware of contact | Prospect MIA | Psycho/Social Issues Prohibit Placement | Psycho/Social Tier 2 or Tier 3 Sex Offender |
| Referred Out, Did not Meet Clinical Admission Date | Referred Out, Other (all others must put description in note) | Referred Post Partum | Requesting Hours Outside of Operation |
| Support helpline / Advice only | Uds Without Opioids | Unable to Make Contact After Several Attempts | Unapproved Facility Transfer |
| Vob Approved, No Contact Information Provided | Vob Approved, Referral Source Kept Prospect | ||
Important
For guidance on how to manage the list of Denial Reasons for your CRM account, please click here.