Coding reviewer

Am I coding this encounter correctly?

Next-best action: Review encounter ENC-502 for possible modifier 59 bundled procedure exclusion.

Pending Coding Review

18 encounters

Missed Implant Charges

$42,500

Coding Accuracy Rate

98.6%

Ingestion Readiness Score

35% remediation required before go-live

Readiness score is calculated starting from a baseline of 100%. Critical deductions (15% per issue) are capped at 40%. Warning deductions (5% per issue) are capped at 25%. remediation is required before production ingestion when PHI-like headers are detected, even if values are redacted.

Candidates generated: 5 work objects

Score Drivers:

• Critical issues: -40% (raw: -105%, capped at 40%)
• Warning issues: -25% (raw: -40%, capped at 25%)

Applied Hard Caps:

• PHI-like forbidden headers detected (cap: 55%)

Remediation Actions

• URGENT: Redact the 3 PHI-like columns in export source feeds before deployment.
• Fix 2 rows with missing required identifiers or invalid dates.
• Reconcile 1 orphan denials that reference unknown claim IDs in the source clearinghouse.
• Auto-escalate 1 stale A/R items (>120 days outstanding) to the high-priority recovery queue.
• Assign operator roles to the 1 work items currently lacking ownership.

Feed Ingestion Coverage

Feed	Received	Accepted	Rejected	Coverage
Encounters	4	3	1	75.0%
Charges	4	3	1	75.0%
Claims	6	4	2	66.7%
Remits	2	2	0	100.0%
Denials	4	3	1	75.0%
Authorizations	2	2	0	100.0%
Payer_correspondence	2	2	0	100.0%
Work_queue	2	2	0	100.0%

Critical Ingestion Blockers

Row Feed (encounters): PHI-like forbidden field header detected in source columns.
Row Feed (encounters): PHI-like forbidden field header detected in source columns.
Row Feed (encounters): PHI-like forbidden field header detected in source columns.
Row 5 (encounters): Unparseable or missing required encounter_date.
Row 5 (charges): Unparseable or missing billed_amount.