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The Denial skill extracts data from denials from insurance companies. A denial is a document that explains the reasons why an insurance company refuses to pay or denies responsibility to pay for medical services or treatment that has been provided to a client or their family member.  The Denial skill is a preview skill. It has been trained on a limited set of documents and is designed to help you quickly get started with processing denials from insurance companies. For production use, you may need to uptrain the skill with your own document samples.
Important. The Denial skill cannot be trained on additional documents.
The Denial skill makes use of a data catalog named DenialReasons, containing the following columns:  
  • DenialReasonID 
  • DenialReasonDescription 
The DenialReasons data catalog is filled in with demo values by default. Before using the skill, remove these demo values and add your own custom data into the DenialReasons data catolog. For more information about data catalogs and how to edit them, see the Skill Designer Guide. The Denial skill recognizes handwritten text. This option is enabled by default. If you do not import handwritten forms, disable the Handwritten option in the skill settings. 

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Languages

  • English

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Extracted Fields

FieldDescription
PayerThe name of the medical insurance company.
Entity (Hospital Name)The name of the health care organization where the service was provided (for example, hospital or clinic).
Patient NameThe name of the patient.
Patient Account NumberThe unique number assigned to the patient to group charges for a hospital visit.
Claim NumberThe number of the claim.
Denial ReasonThe reason why the claim was denied.  
Note: The field can only be obtained from the DenialReasons data catalog. Extraction accuracy depends on the accuracy of the information in the data catalog.
RemarkAdditional information.
Details (Repeating Group)Detailed information about the health care services. These fields are used if the data is presented in a tabular format: Patient First Name, Patient Last Name, Patient Account Number Service End Date, Service Start Date, Denial Reason, Claim Number
Service Start DateThe health care service start date.
Service End DateThe health care service end date.

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Key Fields 

  • Patient Name 
  • Patient Account Number 

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Parameters 

The Denial skill has a default parameter that specifies which data catalog is to be used to look up denial reasons. You can change the value of these parameters in Vantage or in Advanced Designer to modify the field extraction process.
ParameterDescription
DenialReasonsThe predefined data catalog is used for looking up denial reasons. The default value of this parameter is DenialReasons. You can change this value by choosing another available data catalog that has the same structure.