Start with the money, then show why

For the owner

Five questions, answered on page one: How much did you find? What kind of problem is it? Is the amount real or still under review? Which payers or workflows caused it? What should we do next?

For the billing lead

Every finding opens to the claim: what was submitted, what the payer allowed, what the contract should have produced, what the payer was responsible for, whether a payment or remittance was found, and what is still missing. Review states — Unreviewed, Needs review, Validated, Pursued, Waiting on payer, Recovered, Closed, Resolved — are recorded with who and when.

What the first report contains

• Quantified potential financial differences, separated by cause
• Payment variances that require review
• Processing gaps that may represent missing revenue, counted rather than guessed
• Which payers, CPTs, locations, and workflows account for the findings
• Which findings have been validated
• Which contracts appear weak even when the payer is following them
• The claim-level and payment-level evidence behind each material finding
• Important data gaps that prevent a safe conclusion