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.

If you agree with the analysis and no appeal follow-up is needed in Oracle Autonomous Reimbursement, you can mark the denial as closed. To review denial agent analysis:

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. In the Summary section, review the root-cause analysis and suggested resolution.
5. Review the denial details and patient information.
6. If you agree with the Denial agent's analysis and no further follow-up is possible in Oracle Autonomous Reimbursement, select Mark as Closed.

The denial is removed from the worklist in Oracle Autonomous Reimbursement.

Complete any remaining follow-up in the source patient accounting application, such as updating charges and sending a replacement claim to the payer, transferring the denied amount to another health plan, transferring the denied amount to the patient, or writing off the amount.

You can retrieve a closed denial in Oracle Autonomous Reimbursement by searching for it by claim ID.