2 Manage Denial Appeals from Cerner Patient Accounting

The Denial agent is compatible with Cerner Patient Accounting.

The Denial agent automatically analyzes denials for claims that are in Cerner Patient Accounting. When the agent determines that a denial is appealable, it composes an appeal packet and moves the denial to the Denial Appeal Packet Pending Review queue. In the Timeline view of the Claim context, a comment is displayed stating the appeal packet has been composed. You can review, edit, accept, or reject the appeal packet in Oracle Autonomous Reimbursement.

When the agent determines that a denial is not appealable, the denial remains available in the Denials Worklist with a status of Needs Review. You can review the agent's root-cause analysis and suggested resolution, close the denial in Oracle Autonomous Reimbursement, or create an appeal packet by providing additional justification.

Note:

For more information about how claims are processed in Cerner Patient Accounting, see Cerner Patient Accounting Help.

This section contains the following tasks:

• Review Denials in the Worklist
  You can use the Denials Worklist to review denials analyzed by the Denial agent.
• Review Denial Agent Analysis
  You can review the Denial agent's root-cause analysis and suggested resolution for denials with a status of Needs Review.
• 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.
• Review and Edit Denial Appeal Packets
  You can review and edit appeal packets for accuracy in Oracle Autonomous Reimbursement.
• Accept Denial Appeal Packets
  If you are satisfied with the contents of an appeal packet, you can accept and download the packet for use in appeals.
• Reject Denial Appeal Packets
  If you are not satisfied with the denial appeal packet, you can reject the appeal packet.
• Download Accepted Denial Appeal Packets
  You can revisit an accepted appeal packet from the Review Completed list and download it again.
• Update the Status of Denials
  After you have either won or lost the denial appeal, you can update the status of the denial in Oracle Autonomous Reimbursement.