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Continuous monitoring active

Detected issues and opportunities

6 items ranked by revenue impact, urgency and model confidence.

CriticalDenials·94% AI confidenceNorthside Medical Group

Denial rate spike is putting $184K of expected collections at risk

Authorization denials for Northside Medical Group have risen sharply over a 14-day window, well outside normal variation.

$184K
Revenue at Risk
Expected collections exposed over 90 days
+32%
Denial Increase
6.6% → 8.7% denial rate
14 Days
Trend Duration
First anomaly detected Aug 13
InvestigateAsk AI
AI reasoning

Based on historical denial patterns for this client, payer-level authorization trends and recent procedure-level mix changes.

Detected 4 hours ago · Open · Unassigned

High PriorityPayer Intelligence·91% AI confidence

Two payer groups are responsible for 61% of the recent denial increase

Meridian Health Plan and Cascade Benefit Alliance account for the majority of newly denied claims across three clients.

$92K
Meridian Impact
Payer A — authorization denials
$54K
Cascade Impact
Payer B — processing delays
1,284
Claims Affected
Last 14 days
View payer analysisAsk AI
AI reasoning

Payer-level denial concentration is 3.1x the 12-month baseline, with a matched increase in remit code 197.

Detected Yesterday · Open · Reviewed by A. Rao

OpportunityOperations·88% AI confidence

Team productivity variation suggests a $96K monthly improvement opportunity

Three comparable coding teams show an 18% throughput gap on identical specialty mix and claim complexity.

$96K
Monthly Opportunity
If gap closes to top-quartile pace
18%
Performance Gap
Charts per coder per day
3
Teams Affected
Coding Pods B, C and E
Explore opportunityAsk AI
AI reasoning

Normalized for case mix, tenure and specialty, throughput variance exceeds expected range for comparable teams.

Detected 2 days ago · Open · Under review

High PriorityAR Management·86% AI confidenceValley Health Partners

AR over 90 days is deteriorating for Valley Health Partners

Aged AR grew four consecutive weeks, driven by unworked secondary balances after a staffing change.

$78K
Balance at Risk
Secondary and patient balances >90 days
+5.4 pts
AR >90 Days
17.2% → 22.6% of total AR
4 Weeks
Trend Duration
Review accountAsk AI
AI reasoning

Aged bucket growth correlates with a 22% drop in secondary follow-up touches per day.

Detected 3 days ago · Open · Assigned to J. Whitfield

WatchContract Variance·79% AI confidence

Contract variance detected on 214 imaging claims

Allowed amounts fell below the contracted fee schedule for a single imaging code family at Cascade Benefit Alliance.

$31K
Estimated Underpayment
214
Claims Flagged
-6.2%
vs Contracted Rate
Review varianceAsk AI
AI reasoning

Allowed-to-expected ratio drifted below tolerance for four consecutive remittance batches.

Detected 5 days ago · Monitoring

OpportunityFront-End·92% AI confidenceMetro Specialty Care

Eligibility automation lifted clean-claim rate at Metro Specialty Care

First-pass acceptance improved after the front-end eligibility rule set went live; the same rules are unused on two other accounts.

$44K
Replication Upside
If applied to two peer accounts
+3.1 pts
Clean Claim Rate
93.4% → 96.5%
2
Accounts to Replicate
View detailsAsk AI
AI reasoning

Post-implementation rejection volume dropped 41% with no offsetting increase in downstream denials.

Detected 1 week ago · Validated

Resolved this month

Items the team closed after AI detection.

Timely filing risk on 96 secondary claims
$38K protectedClosed Aug 19
Charge capture gap in cardiology diagnostics
$27K recoveredClosed Aug 14
Duplicate claim submissions at Harborview
$11K avoided reworkClosed Aug 08