Denial Categories & Shared Metrics

Synthetic data · Stored example outputs · Simulated processing

Explore the workflow

Reference layer that maps standard CARC and RARC denial codes to an internal taxonomy with per-candidate confidence, surfaces KPI breaches with event-level provenance, and flags week-over-week anomalies anchored to taxonomy nodes. The substrate every downstream automation depends on.

• AI code mapper: WPC CARC/RARC + free-text remarks -> internal taxonomy node with per-candidate confidence and reasoning trace
• AI breach inference: claim event stream -> flagged KPI breaches with provenance back to triggering events
• AI anomaly detection: week-over-week taxonomy-anchored alerts with severity, magnitude, and likely-cause narrative
• 12-node internal taxonomy with parent/child relationships, automation potential, and linked KPIs
• 8 operational KPIs (first-pass yield, denial rate, days in AR, clean-claim rate, denial-overturn rate, cost to collect, write-off rate, payment velocity) with target / warning / critical thresholds and 12 weeks of synthetic observations