Who this workspace is for
Revenue-cycle teams, reimbursement reviewers, practices, groups and hospital teams configuring their organization and preparing intake.
The AuditRes review workflow
From source evidence to a financial outcome
- Control and ingest the data: identify the organization, source, period and missing records.
- Detect leakage or exceptions: compare actual treatment with supported expectations.
- Prove the finding: inspect the evidence and record human verification.
- Prioritize action: assign the next review, dispute or recovery step.
- Track resolution and recovery: retain the response and supporting outcome.
- Report the financial outcome: distinguish exposure, approved adjustments and confirmed recovery.
This is the shared review approach across specialized workspaces. Availability and processing support vary by product; a shared account, unified data store or cross-product automation is not implied.
Medical capabilities
Claims audit
Review claim-level exceptions and supporting reimbursement context. Inspect the financial question and the evidence before accepting a conclusion.
Underpayment review
Compare expected and paid amounts using the available reimbursement records, keeping potential reimbursement differences separate from confirmed recovery.
Denials and exceptions
Inspect denial and exception patterns, related claim detail and next review steps. A classified issue is not proof of payer error.
Evidence center
Follow the records and explanations supporting a claim review. Evidence selection and drill-through preserve the context for human assessment.
Payer scorecards
Inspect operational payer attention signals with their contributing factors. Scores are an explainable operational model, not an external payer rating.
Root-cause intelligence
Explore recurring sources of exceptions and reimbursement friction to help prioritize a review or prevention action.
Resolution and recovery
Track reviewer assignment, follow-up, resolution events and recorded recovered amounts in the workspace workflow.
Leadership reports and financial attribution
Review report packages, financial integrity statements, contract governance and confirmed outcome evidence. Potential, protected and recovered amounts must remain distinguishable.
Pre-submission risk review
Inspect draft-claim risk signals and the available governing contract proof before a submission decision. Missing proof remains explicit.
Submission handoff and tracking
Review submission preparation and post-submission status records. These built screens do not constitute automatic submission to a clearinghouse or payer.
Payer rule and contract intelligence
Review payer rule changes and contract terms as evidence inputs. Human interpretation remains necessary; no blanket payer-policy coverage is claimed.
Prevention intelligence
Prioritize pre-submission and recurring exception exposure in the workspace workflow, with clear separation from realized financial results.
Appeals and follow-up
Prepare and inspect appeal packages and follow-up context in the workspace workflow. A prepared appeal is not proof that a payer received or accepted it.
Post-submission tracking
Review post-submission event and status records alongside the claim context. This built module does not establish an enabled payer transport integration.
Payer rule watch and contract changes
Inspect payer-rule updates and contract-change evidence before deciding whether claim review or operational action is needed. Coverage depends on the supplied records.
Recovery history and analytics
Inspect recorded recovery history and analytics with supporting outcome evidence. Potential adjustments and confirmed financial recovery remain distinct.
Total financial impact
Review the workspace view of financial impact while preserving the distinction between protected revenue, potential exposure and confirmed recoveries.
Intake and limitations
Secure intake and extraction review
Evaluate document intake, extracted fields, OCR assistance and verification controls after the required PHI provisioning. Intake is a review pipeline, subject to confirmed PHI activation.
Security and tenant controls
Authentication and organization context
The application includes sign-in and organization-scoped access, with row-level controls present in the deployed database. PHI-enabled access requires completed organization-specific compliance provisioning.
Start with supporting review guides
Evidence before financial claims
A flagged difference, a proposed adjustment and confirmed recovery are different states. Use source records and human review to explain the finding, retain uncertainty where proof is missing, and report only the outcome supported by the record. No customer results or guaranteed recovery amounts are claimed here.