Morning Brief
Start with prioritized, evidence-bound work, then use practice analytics for context.
Your files, one active workspace
Import related claims and remittances together, or add supporting evidence as your investigation develops.
Where these files belong
Loading company and practice…
Loading active file information…
New practices start empty. Nothing is imported automatically. Import only the approved test files you choose; existing saved datasets are retained between visits.
Representative synthetic patient portfolio · 60 patients · 240 claims
Use customer-like claims, 835 remittance, encounter and later-outcome evidence to analyze longitudinal fictional patients across PREVENT → human decision → CHALLENGE → LEARN.
Company Administrators can load the checksum-verified portfolio directly into the isolated Demo practice. Operators can instead download and import its six data files through the normal customer intake path. The fictional scenario distribution is test coverage, not a payer benchmark, professional adjudication, savings estimate or production evidence.
To add later evidence, drop approved synthetic files above, choose Add to the current dataset, then link relevant supporting documents in the Case Record. Missing and unlinked evidence stays visible.
Optional test records · preview before loading
Explore one claim alongside its payment response, medical note and authorization records. The patient view explains what was loaded and lets you inspect the source documents.
Uses an empty practice only. Existing files will never be replaced. Company Administrators can create a separate example practice; a Claims Specialist loads and reviews the records.
Administration
Keep client setup, access evaluation and operational diagnostics separate from claims work. Permissions are enforced by the service.
Environment validation
Prevent avoidable claim failures
Prioritize claims that have not received a payer response. Review exact claim and encounter facts, resolve evidence gaps, and record an accountable decision before any external action.
Prepare the encounter workspace in Analysis to build the PREVENT queue.
Available in each PREVENT case
- Exact claim, encounter, service and financial facts
- Deterministic claims-side readiness checks and visible mapping exceptions
- Source documents, evidence gaps and ClaimFlair AI investigation
- Accept, Revise, Defer or Reject with append-only decision history
Make the accountable decision
Review pending recommendations across PREVENT, CHALLENGE and LEARN. The evidence version, uncertainty and lifecycle stage travel with every decision.
Prepare the encounter workspace in Analysis to build the decision queue.
Decision controls and safeguards
- Evidence and recommendation identity shown before review
- Accept, Revise, Defer and Reject remain server-authorized
- Changed evidence invalidates the saved workspace until refreshed
- Decisions are attributable and append-only; no decision submits a claim or activates a rule
Challenge from recorded facts
Investigate denied, rejected, paid or partially paid claims only after a payer response is recorded. Keep transaction facts separate from hypotheses and build an internal, unsent packet.
No CHALLENGE queue has been prepared.
Available in each CHALLENGE case
- Matched remittance, adjustment identifiers and source locations
- Recorded payer facts separated from unverified cause hypotheses
- Missing evidence, supporting documents and reviewer actions
- Internal packet, ClaimFlair AI investigation and accountable human decision
Learn from verified later outcomes
Reconcile later payments and reversals, inspect comparable denominators, and review an inactive prevention proposal. Accepting a decision does not activate a rule or train a model.
No LEARN queue has been prepared.
Available in each LEARN case
- Append-only outcome events and exact-cent reconciliation
- Practice-scoped comparable cohort, denominator and missingness
- Inactive prevention proposal with evidence lineage
- Human review without automatic activation, pooling, training or attributed recovery
Patient directory
Find explicitly registered patients in this practice. Imported claims do not automatically establish a patient identity.
Open the directory to load this practice’s registered patients.
Case overview
Issue and next accountable action
Evidence and missing information
Next:
Linked active case facts and document text only. Not a complete medical chart or original-file archive.
Associated billing records
Medical, authorization and correspondence records
Document timeline and evidence gaps
Recorded amounts
Amounts are independent recorded values, not additive slices. Billed less paid is not patient responsibility or a recovery forecast.
What needs attention
Source references and adjustment facts
Prevent → Challenge → Learn
Open a case to inspect its evidence version.
Documents supporting this case
Review relevance before linking an uploaded document. Only explicitly linked documents reach selected-case AI. A link does not establish payer-policy authority. New evidence versions require renewed review.
Document association history
Patient association and evidence history
Associate this exact evidence version with a practice-local synthetic reference. No names, birth dates or member IDs. Nothing is matched or reassigned automatically.
Resetting active files does not purge retained evidence. History shows observations, not cumulative recovery or a reconciled payment ledger.
Review the original synthetic claim snapshot
Run the deterministic review to identify missing claims-side prerequisites. No claim is sent.
Separate the payer record from unverified hypotheses
Build an internal, unsent review packet from the matched synthetic remittance. Nothing is transmitted.
Recorded payer-response facts
Fact versus hypothesis
Reviewer actions
Reconcile the later outcome before proposing a change
Reconcile later synthetic remittance and reversal events in integer cents, then prepare an inactive proposal for human review.
Append-only outcome ledger
Scoped cohort and missingness
Inactive prevention proposal
Investigation and human review
Ask the AI a case-specific question to begin the investigation.
- No history loaded.
Receipts are retained across visits. Historical decisions may reference earlier evidence; compare their recommendation IDs before acting. Only a rationale fingerprint is retained, not the rationale text.
Your claims investigation partner
General guidance is available before importing files.
Enter to send · Shift+Enter for a new line · Answers combine uploaded evidence with clearly labeled industry guidance.
Morning brief
Loading the saved practice work queue…
- Practice
- Not selected
- Role
- Loading access…
- Evidence
- Not prepared
- Work items
- 0
Confirm the practice and prepare its work queue to identify the next accountable action.
Claims performance analysis
A decision-ready view calculated from the files currently loaded into this workspace.
Move from evidence to accountable action
Each case has one primary stage. Select a workspace to see the exact cases, evidence state and next decision.
Prepare the encounter workspace to activate lifecycle drill-down.
Start with the next accountable action
Prepare a saved, prioritized worklist from the active synthetic evidence.
- Confirm the selected company and practice.
- Inspect the saved file list and evidence fingerprint.
- Prepare or refresh the brief, then open priority one.
- Record the human decision in Case Review; nothing is sent automatically.
No saved brief loaded.
| Priority | Case | Stage | System handoff | Work state | Next action | Latest decision |
|---|---|---|---|---|---|---|
| Prepare the brief to see the next task. | ||||||
Each system handoff identifies the evidence owner, transition, and checklist without claiming a live connector. The saved brief reports whether its authorized morning schedule is active. Scheduled preparation only prioritizes work; it never submits a claim, sends an appeal, activates a LEARN proposal, or replaces the required human decision.
Connect services rendered to prevention work
Prepare the encounter view after importing a ClaimFlair structured encounter export. Claims-only review remains available when encounter evidence is missing.
No saved encounter view loaded.
Prepare the encounter view to build the practice work queue.
Morning work queue
Prepare the view to connect issue, impact, evidence, missing information and next action.
Manager interpretation
Denominators, caveats and practice-scoped outcomes will appear here.
Source reconciliation exceptions
- No encounter reconciliation has been prepared.
Like-for-like outcome cohorts
| Payer | Procedure | Setting | Claims | Outcome denominator | Denied | Observed denial rate |
|---|---|---|---|---|---|---|
| No comparable cohorts prepared. | ||||||
The view uses exact case and claim identifiers from a structured export. It is an encounter packet—not a complete chart or claimed EMR API. Inpatient pilot use stays disabled until a real partner mapping is verified. Nothing is submitted, corrected, pooled, trained, or assigned projected recovery automatically.
What these files can support
What deserves attention
Governed decisions
Payment status
Claims by payer
Recorded adjustment identifiers
Identifiers may also appear on paid claims. Select one to inspect its cases.
Rules observed
Priority claim review
Claims ranked from the evidence available in the imported records.
| Case | Payment status | Payer | Procedure | Governed decision | Reason / rule | Billed | Allowed | Paid | Billed less paid |
|---|
Review extracted document fields
Confirm, correct, or reject every extracted value. Nothing from a scan becomes canonical claim evidence automatically.
Ready for a controlled review
Upload one or more approved files to inspect the dataset, cases, and supporting evidence.
Review and verify the recommended action
ClaimFlair records an attributable, append-only decision receipt. It does not submit or alter a claim.
The review could not be loaded
Check that the local application is running, then try again.
Synthetic finding
Information is needed before this claim can move forward
The synthetic response was reconciled and recorded. Review the missing-information reason before taking any real-world action.
What the record supports
- Reason
- Synthetic missing information
- Reconciliation
- Matched and balanced
- Evidence artifacts
- 1 immutable record
- Next action
- Review the cited reason before acting
Review timeline
Why this decision was produced
Canonical input, deterministic rules, source releases, verification, routing, and attributable history for this tenant.
Input validation
0 checksRules evaluated
0 rulesAttributable decision history
0 eventsSource and version provenance
- Evidence ID
—- Canonical ingest
—- Input digest
—- Reference releases
- —
- Component versions
- —
- Retrieval / model
- —
Technical evidence
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