Critical Access Hospital Claims Denial Dashboard Design and Implement Services

The Vendor is required to provide to procure services to design and implement a claims denials dashboard for a critical access hospital (CAH), and to provide training on the dashboard to key CAH staff.
- Data Integration
• Combine electronic medical record (EMR) data and payer remittance (835 or equivalent) files to create a unified denial dataset.
• Establish data mapping and validation processes necessary to support ongoing refreshes of denial data.
- Denial Analytics & Visualization
• Develop aggregate views of denials by, at a minimum:
o Payer
o Service line
o Denial code/reason
• Enable drill-down capabilities from aggregate views to patient-encounter level details to support operational review and follow-up.
• Incorporate standard filtering and segmentation (e.g., date range, location, service type) to allow users to explore denial trends over time.
- Workflow Attribution (High-Level)
• Within the dashboard, provide high-level attribution of denied claims back to major components of the revenue cycle workflow (e.g., registration, coding, billing, follow-up) to support operational awareness and prioritization.
• Present these attributions in a manner that is understandable to CAH leadership and staff, recognizing varying levels of data and analytics experience.
- Activities will include:
• Facilitate training sessions with key staff to walk through the dashboard, including how to navigate views, apply filters, and review denial details.
• Confirm that designated users understand how to interpret the core denial metrics and visuals presented in the dashboard so they can use the tool to support denial management and revenue integrity activities.