gitea_admin/northlake-health
1
0
Fork 0
Code Issues Pull Requests Actions Packages Projects Releases Wiki Activity

feat: slow-payer and appeal-scorecard checks on the Run review page

Browse Source 
Co-Authored-By: Claude Fable 5.1 <noreply@anthropic.com>
This commit is contained in:
Yashas 2026-09-16 16:16:58 +05:30
parent 6af647b462
commit de86cd9859
2 changed files with 5 additions and 1 deletions
Show Stats Download Patch File Download Diff File Expand all files Collapse all files

1
src/api/config.ts
View File

@ -201,6 +201,7 @@ export const FINDING_KIND: Record<string, string> = {
coding: 'Coding', coding: 'Coding',
provider_coding: 'Single provider — coding', provider_coding: 'Single provider — coding',
underpayment: 'Underpayment', underpayment: 'Underpayment',
slow_payer: 'Slow payer',
documentation: 'Documentation', documentation: 'Documentation',
medical_necessity: 'Medical necessity', medical_necessity: 'Medical necessity',
timely_filing: 'Timely filing', timely_filing: 'Timely filing',

5
src/screens/RunReviewScreen.tsx
View File

@ -67,10 +67,13 @@ export function RunReviewScreen() {
<li>Denial rate vs 8-week baseline: by payer, reason code, department, front desk, week, procedure, provider</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> <li>Underpayments: paid vs allowed by payer and procedure, vs baseline</li>
<li>Slow payers: claims sent 31–60 days ago still unanswered, by payer</li>
<li>Appeal scorecard: overturn rate by payer, used to size recoveries and order appeal work</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; more than Materiality threshold: denied count up more than 40% on at least 25 claims; more than
$100K in appeals expiring; or paid/allowed down more than 10 points or a $50K shortfall. $100K in appeals expiring; paid/allowed down more than 10 points or a $50K shortfall;
or more than a quarter of a payer's month-old claims still unanswered, worth over $250K.
Items below the threshold are listed, not flagged. 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">