Create Appeal Packets for Denials Needing Review

If you review a denial with a status of Needs Review and determine that the denial can be appealed, you can ask the Denial agent to create an appeal packet.

The justification you provide guides the agent as it reprocesses the denial and prepares the appeal packet. To create appeal packets for denials needing review:

1. In the Denial Management module, access the denial worklist.
2. Filter or search for a denial with a status of Needs Review.
3. Select the denial.
4. Review the root-cause analysis and suggested resolution.
5. Select Create Appeal.
6. Enter a justification for creating the appeal packet.
7. Select Create Appeal.

The Create Appeal window is closed, the denial status changes to Analyzing Root Cause, and the Create Appeal button is disabled while the Denial agent reprocesses the denial. When processing is complete, the denial status changes to Appeal Packet Composed. The root-cause analysis and suggested resolution are updated based on your justification, and the appeal letter and attachments are available in the Actions section.

If the justification is invalid, the denial status changes to Appeal packet creation failed and an error message is displayed. The Create Appeal button is enabled again so you can revise the justification and resubmit the request.

After the appeal packet is composed, you can review and edit the denial appeal packet.