Healthcare
Catch billing errors before claims go out the door
EHR records, billing codes and insurance responses connected to flag patterns that cause denials before submission.
Why this decision matters.
Denied and underpaid claims are a working capital problem disguised as an administrative one. Teams staff up to rework denials, which treats the symptom, while the pattern generating them stays in place month after month.
The failure mode is a denial report with no lineage. It tells you the volume by reason code and nothing about which service lines, payers, or documentation gaps produce them, so the response is a productivity push rather than a fix.
When the cause is identifiable, most of the volume traces to a small number of patterns: a payer rule change, a documentation field that goes unfilled, a service line with an outdated code mapping. Fixing those permanently removes the rework instead of absorbing it.
Comparing tools for healthcare? See how SIGNLD compares with Tableau. For the underlying numbers, read tracking revenue per visit by payer.
How SIGNLD answers it.
Step 01
Connects to your source systems
Read-only access to your clinical and claims database (Microsoft SQL Server), your financial system of record (NetSuite), and the revenue-cycle data store behind reporting (PostgreSQL).
Step 02
Builds the graph across those systems
Encounters, claims, codes, payers, denials, and remittances are linked so a denial is connected to the documentation and coding decisions that produced it.
Step 03
Returns a ranked brief
The brief ranks denial and underpayment causes by dollars at stake, identifies the service lines and payers involved, and recommends the coding or documentation change with the largest recovery.
Reads from.
SIGNLD connects read-only to your existing systems. 800+ integrations available.
What the brief looks like.
The question
Which billing codes are generating the most denials, and why?
What SIGNLD found
Code 99214 is being used for visits that average 12 minutes in documented provider time. Payer guidelines for 99214 require 30-39 minutes. The mismatch is creating a 43% denial rate on this code for one payer, but the pattern is invisible at the provider level because denials are tracked by billing staff, not clinical staff.
Evidence
- 99214 average documented provider time: 12 minutes across 84 claims in Q3
- 99214 denial rate from Payer X: 43% vs 8% industry benchmark
- Revenue at risk from pending 99214 claims: $67K
Recommended move
Audit all pending 99214 submissions against provider documentation before submitting. Implement a documentation prompt in the EHR for this code. Estimated denial reduction: $67K in protected Q3 revenue.
29% reduction in claim denials
Illustrative brief. Figures are sample data, not customer results.
Questions.
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