Help · Claims and revenue integrity
How a claim is scored
Every claim is scored before it is filed. The score is the probability that the payer reduces it, based on rules about the claim, not about the patient.
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Why the queue is not sorted by risk
A claim with an eighty per cent chance of being cut by six thousand rupees matters less than one with a twelve per cent chance of being cut by four lakh. The worklist is ordered by risk multiplied by amount, which is the only ordering that puts the biggest number at the top.
The weights calibrate on your data
A rule that never fires at your hospital loses weight over time. The rules are visible and so are their weights.
More in Claims and revenue integrity
Room rent caps and proportionate deductionThe single largest preventable deduction in Indian hospital billing, and where to stop it.Raising a query on a short-paymentThe window, what to attach, and what “as per policy terms” actually means.Documentation deficienciesThe hospital-side causes, in the order they cost money.
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