Case Study: SEHA reduces medication payment denials and saves AED 2.82M with Cerner clinical decision‑support alerts

SEHA saves money, helps patients by creating payment denial alerts

SEHA Abu Dhabi Health Services Company (SEHA), a large health system with 2,723 inpatient beds across 12 hospitals and more than 65 outpatient clinics, faced substantial insurance payment denials for medications—especially proton pump inhibitors (PPIs) and biologic drugs—when prescriptions lacked appropriate diagnosis documentation. In January 2014, PPI denials alone averaged AED 1.4 million per month, creating both financial strain and barriers to patient care.

SEHA implemented detailed, actionable clinical decision support alerts in its Cerner EHR that fire when a diagnosis is missing and guide physicians on proper documentation and prescribing steps; the alerts were redesigned to be harder to dismiss. From July 2015–June 2016 this approach cut medication denial costs by about AED 2,820,000 (≈ $767,000 USD), and PPI denials fell from AED 1.4M/month to AED 0.31M and then to AED 0.07M by July 2016, improving both reimbursement rates and the patient experience.

SEHA

Ahmed Bekheet

Corporate Senior Clinic Application Analyst