Review Denials in the Worklist

You can use the Denials Worklist to review denials analyzed by the Denial agent.

The total count of worklist items is displayed at the top of the worklist. To review denials in the worklist:

1. In Oracle Autonomous Reimbursement, select Denial Management.
2. Review the information displayed for each denial.
3. Use the filters or sort options to find the denials you want to review.
4. Select a denial to open the denial details.

The worklist displays the following information for each denial:

• Claim details: Claim ID or claim number, payer, health plan priority and health plan name, claim creation date, and billing period.
• Denial details: Denial category, claim adjustment group code, claim adjustment reason code (CARC), remittance advice remark code (RARC), and last remit date.
• Encounter details: Patient name, receivable owner, and facility.
• Denial amount: The amount associated with the denial.
• Work item details: The age of the item in days and the current status.

You can filter the worklist by claim ID, denial category, health plan, payer, receivable owner, reason code (CARC), remark code (RARC), and facility. You can also use predefined status filters. When you first open the worklist, the Appeal packet composed and Needs review status filters are selected by default.

You can sort the worklist by denial amount, claim date, and remit date. For Oracle Health Patient Accounting customers, you can also sort by expected reimbursement amount.

The following statuses can be displayed in the worklist:

Status	Description
Analyzing Root Cause	You requested appeal packet creation and the Denial agent is processing the request.
Appeal Packet Accepted	The appeal packet was accepted. The denial was marked as appealed or moved to the appeal submitted queue in the source patient accounting application.
Appeal Packet Composed	The Denial agent composed an appeal letter and the appeal packet is waiting for review.
Appeal Packet Creation Failed	The request to create an appeal packet failed during processing.
Appeal Packet Rejected	The appeal packet was rejected.
Needs Review	The Denial agent classified the denial as not appealable and the denial requires your review.