Sample Deliverable
A fictional, de-identified example showing how OriNova organizes findings and next steps.
Illustrative sample only: The figures below are invented and do not represent a real client, guarantee, or expected result.
Executive Findings Summary
A focused mock review of 125 claims identified 31 items requiring additional client or billing-team review. Findings included denial follow-up candidates, potential reimbursement discrepancies, posting questions, and patient-responsibility review items.
125Claims reviewed
31Items flagged
7High-priority items
4Root-cause themes
Example Findings
| Reference | Finding | Evidence | Priority | Recommended action |
|---|---|---|---|---|
| DEMO-014 | Potential reimbursement discrepancy | Allowed amount lower than available comparison; contract confirmation required. | Important | Client billing team should verify contract terms and payer processing. |
| DEMO-027 | Authorization denial follow-up candidate | Authorization reference appears in internal notes; payer-specific validation required. | Urgent | Confirm authorization scope and filing deadline before appeal decision. |
| DEMO-042 | Payment posting review | EOB reflects payment, while mock billing status remains open. | Important | Compare remittance, posting, adjustment, and account balance. |
| DEMO-063 | Patient responsibility review | Deductible assignment appears to have been written off in the mock ledger. | Monitor | Verify patient ledger and write-off reason. |
30-Day Action Plan
- Review urgent authorization and timely-filing items first.
- Validate expected reimbursement sources before pursuing underpayment concerns.
- Compare paid EOBs with open-account and posting status.
- Track repeated payer and root-cause patterns for operational correction.
Scope reminder: OriNova provides analytical findings and operational recommendations. The client remains responsible for coding decisions, payer communication, claim submission, legal decisions, clinical documentation, and recovery actions unless separately agreed in writing.