Denial Patterns

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5.1 “WNL” alone

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Sources and clinical references

  • CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 7 — Home Health Services. Skilled-care coverage, documentation sufficiency, and homebound criteria.
  • 42 CFR Part 484 — Conditions of Participation for Home Health Agencies (§484.55; §484.60).
  • CMS OASIS-E2 Guidance Manual, effective April 1, 2026.
  • SawaOS DGEX Foundations module (1.1–1.8) and the “Common audit and denial risks” sections of the body-system modules — the sources of the extended patterns above.
  • Community Health Accreditation Partner (CHAP) Standards of Excellence for Home Health. [Agency-fill: insert exact title, version, section, and date.]

Standing flags. Display numbers are provisional; the stable module code is the key. The CHAP citation is agency-fill — insert the exact title, version, section, and date. Verify each pinned guideline against the current published edition at time of use.

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