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feat: two more finding kinds — single-provider coding, underpayment

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The review now cuts by procedure and by provider, and checks paid vs allowed
for short-payments. The Run review page lists the checks and the thresholds
that apply to each.

Co-Authored-By: Claude Fable 5.1 <noreply@anthropic.com>
This commit is contained in:
Yashas 2026-09-16 15:53:28 +05:30
parent d41583c68b
commit 6af647b462
2 changed files with 7 additions and 3 deletions
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2
src/api/config.ts
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@ -199,6 +199,8 @@ export const FINDING_KIND: Record<string, string> = {
payer_policy: 'Payer rule change', payer_policy: 'Payer rule change',
front_desk: 'Front-desk / registration', front_desk: 'Front-desk / registration',
coding: 'Coding', coding: 'Coding',
provider_coding: 'Single provider — coding',
underpayment: 'Underpayment',
documentation: 'Documentation', documentation: 'Documentation',
medical_necessity: 'Medical necessity', medical_necessity: 'Medical necessity',
timely_filing: 'Timely filing', timely_filing: 'Timely filing',

8
src/screens/RunReviewScreen.tsx
View File

@ -64,12 +64,14 @@ export function RunReviewScreen() {
<p className="font-semibold text-ink">Checks performed</p> <p className="font-semibold text-ink">Checks performed</p>
<ul className="mt-1.5 list-disc space-y-0.5 pl-4"> <ul className="mt-1.5 list-disc space-y-0.5 pl-4">
<li>Claims data reconciled against the finance monthly summary</li> <li>Claims data reconciled against the finance monthly summary</li>
<li>Denial rate vs 8-week baseline: by payer, reason code, department, front desk, week</li> <li>Denial rate vs 8-week baseline: by payer, reason code, department, front desk, week, procedure, provider</li>
<li>Unfiled appeals with deadlines within 14 days</li> <li>Unfiled appeals with deadlines within 14 days</li>
<li>Underpayments: paid vs allowed by payer and procedure, vs baseline</li>
</ul> </ul>
<p className="mt-2 text-xs text-faint"> <p className="mt-2 text-xs text-faint">
Materiality threshold: denied count up more than 40% on at least 25 claims, or more Materiality threshold: denied count up more than 40% on at least 25 claims; more than
than $100K in appeals expiring. Items below the threshold are listed, not flagged. $100K in appeals expiring; or paid/allowed down more than 10 points or a $50K shortfall.
Items below the threshold are listed, not flagged.
</p> </p>
<p className="mt-2 inline-flex items-center gap-1.5 text-xs text-faint"> <p className="mt-2 inline-flex items-center gap-1.5 text-xs text-faint">
<Database className="h-3.5 w-3.5" /> <Database className="h-3.5 w-3.5" />