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Denial Management

Claim denial analysis, appeal, and prevention

Complexity: Complex | Duration: 30m+ | Category: Industry/Healthcare

Tags: denial appeal revenue-recovery healthcare

Workflow Diagram​

Steps​

Step 1: Receive denial​

Agent: denial

specialist - Capture denial details

Step 2: Analyze reason​

Agent: denial

specialist - Identify denial cause

Step 3: Determine action​

Agent: denial

specialist - Decide appeal or correction

Step 4: Gather documentation​

Agent: clinical

specialist - Compile supporting info

Step 5: Submit appeal​

Agent: denial

specialist - Send appeal to payer

Step 6: Track outcome​

Agent: denial

specialist - Monitor appeal status

Agent: denial

specialist - Identify prevention opportunities

Usage​

To execute this workflow:

/workflow industry/healthcare/denial-management.workflow

See other workflows in this category for related automation patterns.