Ranks by recoverable value
What is genuinely collectable, not what was billed — so a contractual adjustment you already agreed to never pushes a claim up the list.
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AI Worklists
Stop working the oldest claim. Work the recoverable one.
Every open claim is ranked on what can actually be done about it today, how much is genuinely recoverable, and how close it is to a deadline. Your team opens a shortlist worth working rather than a backlog sorted by age.
- You can see why a claim ranks
- Split by stage of the cycle
- A next action on every row
The AI Priorities worklist: the priority score, the denial and deadline flags, the recommended action, and the reasoning behind it on every row.
What it does
Protects the deadline
A workable claim with a closing appeal or filing window surfaces regardless of size, because a missed window is not a partial loss.
Recommends the next step
Not “follow up” — the specific move. Append the modifier, attach the primary EOB, open a pricing dispute, with the root cause and the evidence to gather.
Splits work by stage
Pre-claim, in-flight and recovery are different jobs. Somebody clearing authorisation holds should not be scrolling past denials they cannot act on.
How it works
- 1
Every open claim is assessed
What state it is in, what it is worth, how long it has sat and how much window is left.
- 2
It is ranked and flagged
A priority and a tier, plus the badges that explain them — the denial reason, days remaining, missing paperwork.
- 3
A recommendation is attached
The root cause, the next step, the evidence to gather, and how likely this kind of claim is to be recovered.
- 4
The list opens as a shortlist
Filtered to what is genuinely worth working, with the full book one toggle away.
Ranking nobody can explain is ranking nobody trusts
A team will quietly abandon a worklist the moment its order stops making sense. So every claim can tell you why it sits where it does, in terms a biller recognises — and the answer is the same every time they look.
- Open any claim and see what drove its position, in plain language rather than a score with no story.
- The same claim always ranks the same way, so two people looking at the same queue see the same thing.
- The reasoning is written for a biller, not for a data scientist.
- Nothing is hidden behind “the model decided” — if the order looks wrong, you can see why and tell us.
What the ranking weighs
- Is there a move available today
A coding error you can correct and rebill beats one already sitting with the payer.
- How much is genuinely recoverable
The balance actually at stake, not the billed amount.
- How long it has been sitting
Older money is harder money, and it gets weighted that way.
- How much window is left
A closing appeal or filing deadline outranks almost everything.
Rows that say what is actually wrong
A worklist has to be readable at a glance or it becomes a spreadsheet people export and ignore. Each row carries a small set of flags drawn from the claim itself, so the shape of the work is obvious before anyone opens it.
- Appealable denials are marked as such, so nobody spends an afternoon appealing a deductible.
- Outstanding payer paperwork and “gather this before you act” evidence are deliberately different labels.
- Deadline flags escalate as the window narrows and keep counting after it has closed.
- Filing and appeal windows follow each payer's own terms rather than one blanket assumption.
Row vocabulary
- Appealable
A denial with a live dispute path still open.
- Aging out
Days remaining on the appeal or filing window.
- Missing docs
The payer is pending on records or coordination of benefits.
- Evidence needed
The recommendation names documents to gather first.
- Underpaid
Remitted below contract, and the claim is still open.
Status is a poor proxy for a denial
Most worklists filter on claim status, and that quietly hides work. A claim can be denied and then partially paid, or denied and already under appeal. In both cases the status no longer reads “denied” — but the money is still contested, and a status filter will walk straight past it.
- Denials are tracked from what happened to the claim, not inferred from its current status label.
- Contractual adjustments and patient balances are kept out of denial counts — neither is a denial, and neither should start an appeal clock.
- Encounters blocked before submission are ranked on their own terms, by what is at risk and how close filing is.
- Resolved work stays available for zero-balance review rather than disappearing.
Lanes
- All work
Everything open, ranked. A to-do list, not an archive.
- Pre-claim
Coverage, authorisation, coding and submission holds.
- In-flight
Submitted and waiting. Chase what has gone quiet.
- Recovery
Denied, underpaid or under appeal.
- Resolved
Paid and closed, kept for zero-balance review.
- By what is worth doing next
Ranked
By what is worth doing next
Not by whatever happens to be oldest
- Open any claim and see why
Explainable
Open any claim and see why
The order is never a black box
- Closing windows surface first
Deadline aware
Closing windows surface first
A missed window is a total loss, not a partial one
- Pre-claim, in-flight, recovery
By stage
Pre-claim, in-flight, recovery
So a queue matches the job someone is doing
Common questions
- Why does a small old claim rank below a new large one?
- Because age is only one part of the picture. A claim you can act on today with real money at stake is worth more of your team's time than an old one with a balance that costs more to chase than it returns.
- Can we see why a claim is ranked where it is?
- Yes, on any claim. The explanation is written for a biller and stays the same every time you open it, so the queue can be questioned rather than just obeyed.
- Can we still work the list our own way?
- Yes. Search across claims, patients, procedure and denial codes, filter by payer, status, owner and tag, or turn the shortlist off and see the entire book.
- How does this fit with our existing queues?
- It is a prioritisation layer, not a replacement workflow. Owners, statuses and assignment work the way your team already works — what changes is the order they come in.
Explore the rest of the platform
- Claim IntelligenceCatch the denial while the claim can still be fixed.
- Revenue RecoveryFind the shortfall the payer never told you about.
- AI AppealsA complete appeal letter, built from the claim itself.
- AI CopilotAsk a question in plain English, get an answer you can check.
- Revenue IntelligenceOne set of numbers, so no two reports disagree.
See AI Worklists run against your own claims.
We’ll walk your team through a live workspace using a sample of your data, and show exactly where the recoverable dollars are.