Help & how-to
A quick guide to the workflow, plus answers to common questions. For anything not covered here, see Contact us.
How-to guide
The core workflow, in order
- Review the dashboard. The overview shows your current denial rate, open pipeline at risk, and the highest-risk open claims across every payer and provider.
- Work the claims queue. Open Claims to filter by status, payer, or risk level, and pick up the next claim that needs attention.
- Resolve flags on a claim. Each claim detail page lists open coding, bundling, modifier, or documentation flags. Resolving or dismissing a flag immediately recomputes that claim's denial-risk score.
- Assign, note, and change status. Use the claim detail page to assign a claim to a teammate, leave a note for context, and move the claim through its workflow status as work progresses.
- Connect and monitor EHR feeds. The Integrations page shows the status of each connected EHR and its sync history, so you know new charges are flowing in.
Frequently asked questions
›How is the denial-risk score calculated?
The risk score (0–100) is built from a claim's open coding/documentation flags, the payer's historical denial rate, how long the claim has been open, and the billing provider's own denial track record. Every point is traceable to a specific reason, shown in the risk breakdown on the claim detail page — there's no black-box model.
›Why did a claim's risk score change after I resolved a flag?
Resolving or dismissing a flag removes it from the set of open issues the risk engine considers, so the score is recalculated immediately from whatever flags remain open.
›What do the flag severities (low/medium/high/critical) mean?
Severity reflects how likely the issue is to cause a denial or delay if left unresolved — for example, a missing operative note (documentation gap) is typically more severe than a minor modifier inconsistency. Critical flags are surfaced prominently on the dashboard.
›How do EHR integrations work, and is my data real?
Each connected EHR (Epic, Cerner/Oracle Health, athenahealth) uses an adapter that normalizes that system's native data shape into a common claim format. In this demo, all adapters generate realistic synthetic data — no real patient records or EHR credentials are used. See the README for how to point an adapter at a real system.
›Can I undo a status change or flag resolution?
Status changes and flag resolutions are tracked with a full audit trail on the claim, so you can see who changed what and when. Reach out to an admin/supervisor on your team if a change needs to be reversed.
›Who can see my claims data?
Access is limited to signed-in members of your billing team. See our Privacy Policy for details on how data is handled.