Score every claim by its odds of paying.
Stop working claims in row order. The scoring engine weighs what decides recovery, then tells your team which claims to work, which to watch and which can wait.
Each claim is scored on its balance, its denial reason, the payer's track record and how much of the payer's filing window is already gone. The result is a recovery score, an expected dollar value and a next step such as resubmit, appeal, send documentation or follow up.
Admins own the rulebook. Weights, age bands, per-payer filing limits and the thresholds that turn a score into work, watch or low priority can all be changed. Test a made-up claim first, then recalculate every open claim without touching allocations or recorded outcomes.
What you get
Recovery score
A score out of 100, with the reasons behind it shown part by part.
Expected recovery
The odds of paying turned into a dollar figure for each claim.
A plain-English next step
Resubmit, appeal, send documentation, follow up or review for write-off.
Three clear decisions
Recommend work, watch or low priority, set by thresholds you control.
Filing deadlines in view
See how much of the payer's filing window is already used.
Safe recalculation
Apply new rules to open claims without disturbing allocations or outcomes.
Every claim gets a verdict.
The scoring engine weighs the balance, the denial reason, the payer's track record and how much of the payer's filing window is already gone. Out comes a recovery score, an expected dollar value and a plain-English next step. Try it below: this is the default rulebook, running in your browser.
Claim ticket
CLM-20418
Aetna
Patient: hidden
Weighed against the largest balance in the file ($10,000)
Payer filing limit
Denial reason
Claim status
Recovery score 60. Recommend work. Next step: Correct CPT/ICD coding and rebill the claim.
60
Recovery score
Strong recovery score (60) and balance >= $50
- Odds of paying
- 54%
- Expected recovery
- $670of $1,240
Next step
ResubmitCorrect CPT/ICD coding and rebill the claim
Why this score
60 / 100
- Filing windowUnder half the filing window used, still in prime window (47 of 120 filing days used, 73 left)13.0/15
- BalanceOutstanding balance $1240.00 (relative weight)3.1/25
- Denial reasonCoding error is typically resolvable via correction + rebill17.0/20
- Payer historyPayer historically pays 78.0% of charges in this dataset11.7/15
- CPT patternNo comparable CPT recovery history yet, neutral CPT signal5.0/10
- Provider patternNo provider denial history yet, neutral provider signal5.0/10
- Claim statusActive denial/rejection requires action5.0/5
Admins own the rulebook: weights, age bands, per-payer filing limits and the thresholds that turn a score into work, watch or low priority. Test a made-up claim, then recalculate every open claim without touching allocations or recorded outcomes.