An independent look at how claims move through your organisation: what gets denied and why, where coding drifts from the published rules, which steps are being done twice, and which are being done by a person who should not have to.
In that order, and the order is the point — automating a process that is wrong only produces the wrong answer faster and at scale.
A sample of your own claims, coded and documented by your own team, reviewed against the rules your regulator currently publishes. Output is a finding list with the money attached to each finding, not a score out of ten.
Independent, documented, and defensible if a payer or the regulator asks. Covers class assignment, counting rules, documentation sufficiency and the denial patterns that follow from getting them wrong.
Rebuilding the steps between encounter and payment: who checks eligibility and when, where authorisation actually sits, how a denial gets back to the person who can fix it, and what stops the same denial recurring next month.
The findings become the curriculum. Your team is trained on what the audit showed they are getting wrong, not on a generic syllabus.
Only the parts that are repeatable and rule-bound: eligibility and authorisation checks, coding review against the schedules, denial pattern analysis, regulatory reporting. A person still signs the claim.
