Denial Management 26.Q1.MR1

Highlights

The Denial Management agent now is available to help create denial appeal packets.

Intended Audiences

This topic is intended for Oracle Health customers who use Oracle Health EHR to manage denials.

Solution Change Details

The following solution changes are available with this release:

Solution Change	Description and UI Impact	Reference Materials	Validation Guidelines	Implementation and Maintenance Impact
Denial Appeal Packet - OHPRI-3	The Denial Management agent works with data entered in Cerner Patient Accounting to compose an appeal packet for denials that require an appeal letter for resolution. The agent can also provide root-cause analysis for those denials. UI Impact: Workflow (Automatic) The Denial Management agent creates an appeal packet, which allows you to review, edit, and download to communicate with payers.	See Denial Management Agent Insurance Collector User Guide for more information.	Verify that you can successfully complete the workflows in the Reference Materials.	Implementation Impact: None Maintenance Impact: None
Denial Worklist Enhancements	Component: Denial Management Worklist The worklist now displays all denial items and includes additional claim, payer, denial, patient, amount, and status details. UI Impact: Workflow Users can review more denial information directly from the worklist and filter by additional values, such as payer, denial reason code, and remark code.	See Denial Management Agent Insurance Collector User Guide for more information.	Verify that you can view denial items, review expanded denial details, and filter the worklist.	Implementation Impact: None Maintenance Impact: None
Root-Cause Analysis for All Denials	Component: Denial Management Agent The agent now provides root-cause analysis and suggested resolution for denial items, including items that are not recommended for appeal. UI Impact: Workflow Users can review the root cause and suggested resolution from the denial details.	See Denial Management Agent Insurance Collector User Guide for more information.	Verify that denial items include root-cause analysis and suggested resolution.	Implementation Impact: None Maintenance Impact: None
Assisted Appeal Packet Creation (OHPRI-5680)	Component: Denial Management Agent Users can initiate appeal packet creation when the agent does not automatically create one. The agent uses the user's justification to generate the packet. UI Impact: Workflow Users select Create Appeal, enter a justification in a drawer, and then review and edit the generated packet.	See Denial Management Agent Insurance Collector User Guide for more information.	Verify that you can upload, map, and save an appeal letter template and use it for an appealable denial.	Implementation Impact: None Maintenance Impact: Low Maintain templates as payer and health plan requirements change.