Dashboard
Overview of claim denial trends and system performance
Denial Rate
8.2%
-1.5%
Revenue Lost
$1.2M
+5%
Claims Processed
15,000
+10%
Revenue Recovered
$850K
+12%
Denial Rate Over Time
8.2%
Last 12 Months
-1.5%
Denials by Reason
15,000
Last Quarter
+10%
Outstanding Claims by Age
$625,000
Total Outstanding
Denials Analysis
Analyze historical denial data to identify trends and patterns.
Denial Rate Over Time
12%
Last 12 Months
-2%
| Denial Reason | Number of Denials | Percentage |
|---|---|---|
| Missing Information | 250 | 30% |
| Non-Covered Service | 200 | 24% |
| Prior Authorization Required | 150 | 18% |
| Incorrect Coding | 100 | 12% |
| Duplicate Claim | 50 | 6% |
| Payer | Denial Rate | Common Reasons |
|---|---|---|
| Medicare | 15% | Missing Information, Non-Covered Service |
| Blue Cross | 10% | Prior Authorization Required, Incorrect Coding |
| United Healthcare | 8% | Duplicate Claim, Missing Information |
New Claim Prediction
Estimated:
Claim Prediction Results
Review the prediction for this claim and take necessary actions.
Claim ID
Patient ID
Provider ID
Service Type
Claim Amount
Diagnosis Code
Insurance Plan
Status
Denial Risk
Datasets
Manage your datasets and track their processing status.
Drag and drop or browse to upload
Supported file types: CSV, XLSX
| Dataset Name | Upload Date | Status | Actions |
|---|---|---|---|
| Claims Data 2023 | 2023-11-15 | View Details | |
| Claims Data 2022 | 2023-11-10 | View Details | |
| Claims Data 2021 | 2023-11-05 | View Details |
Payer Rules & Guidelines
| Payer | Service | Denial Reason | Rule Description | Status | Last Updated |
|---|---|---|---|---|---|
| Payer A | Inpatient Care | Lack of Medical Necessity | Rule 1: Inpatient care requires prior authorization and must be deemed medically necessary by the payer's review team. | 2023-08-15 | |
| Payer B | Outpatient Surgery | Incorrect Coding | Rule 2: Outpatient surgical procedures must be coded accurately using the latest ICD and CPT codes. | 2023-07-22 | |
| Payer C | Diagnostic Testing | Insufficient Documentation | Rule 3: Diagnostic tests require complete and accurate documentation, including physician orders and test results. | 2023-09-01 | |
| Payer A | Physical Therapy | Exceeded Benefit Limits | Rule 4: Physical therapy services are subject to annual benefit limits, which may vary based on the member's plan. | 2023-06-10 | |
| Payer B | Mental Health Services | Non-Covered Service | Rule 5: Prescription medications must be on the payer's formulary to be covered at the lowest cost-sharing level. | 2023-08-29 | |
| Payer C | Emergency Room Visits | Inappropriate Use of ER | Rule 6: Emergency room visits for non-emergency conditions may be subject to higher cost-sharing or denial. | 2023-07-05 | |
| Payer A | Specialist Consultations | Lack of Referral | Rule 7: Specialist consultations often require a referral from a primary care physician. | 2023-09-12 | |
| Payer B | Prescription Medications | Non-Formulary Drug | Rule 8: Prescription medications must be on the payer's formulary to be covered at the lowest cost-sharing level. | 2023-06-28 | |
| Payer C | Durable Medical Equipment | Prior Authorization Required | Rule 9: Durable medical equipment requires prior authorization and may be subject to medical necessity review. | 2023-08-03 | |
| Payer A | Preventive Care | Frequency Limits | Rule 10: Preventive care services, such as annual check-ups, have frequency limits based on age and gender. | 2023-07-19 |
User Management
Manage user roles and permissions within the system.
| User | Role | Status | Actions |
|---|---|---|---|
| Dr. Emily Carter | Administrator | Edit | |
| Dr. Robert Harris | Analyst | Edit | |
| Dr. Olivia Bennett | Reviewer | Edit | |
| Dr. Ethan Clark | Analyst | Edit | |
| Dr. Sophia Turner | Reviewer | Edit |
Reports
Generate customized reports on denial trends, system performance, and other key metrics. Filter data and export reports in various formats.
| Denial Reason | Number of Denials | Percentage |
|---|---|---|
| Missing Information | 120 | 30% |
| Incorrect Coding | 80 | 20% |
| Prior Authorization Required | 60 | 15% |
| Non-Covered Service | 50 | 12.5% |
| Other | 90 | 22.5% |