computed concept · mined from SQL · revfind
Denial / underpayment
Detects denials, short-pays, and underpayment variance — the core RevFind output.
Pipelines
20/53
compute it in SQL
Customers
17
CCP, Commonwealth, ECP, EyeSouth, HeatonEye, ISpine…
Distinct SQL
85
distinct implementations
the SQL
Steps that compute it
The concrete SQL steps whose text computes denial / underpayment, in plain language (✨ Gemini gloss), most-reused first. The count is how many steps across all trees run this same SQL; the link opens an example pipeline's task tree.
Loads denial category dimensions from adjustment code rollup data to categorize claim denials.
Builds a comprehensive account summary table by combining patient, insurance, and financial data for detailed encounter reporting.
Loads granular charge-level details including procedure codes, modifiers, and payment metrics for individual service line analysis.
Builds the remittance adjustment transformation table by categorizing insurance denials and mapping reason codes to standardized adjustment types.
Aggregates remittance adjustments to calculate total contract, patient, and denial amounts at the charge level for updated accounts.
Builds a temporary table to determine claim status, member IDs, and coordination of benefits order for remittance data.
Calculates and loads financial metrics like payments, adjustments, and denials for specific accounts into the charge measures table.
Processes and loads remittance adjustment details, including denial categories and group codes, from electronic remittance advice into the transformation table.
Aggregates insurance remittance adjustments and denial categories to summarize payment impacts at the encounter level.
Updates or inserts claim notes and status information to maintain a history of billing actions and denial reasons.
Updates or inserts denial-specific claim notes to track rejection reasons, provider details, and claim status changes.
Aggregates claim adjustments to identify and categorize initial and current denials based on standardized reason code rollups.
Aggregates remittance activity by charge to calculate paid, denied, and allowed amounts for financial analysis.
Determines the coordination of benefits order and current claim status by analyzing historical remittance and adjustment data.
Consolidates remittance payments and adjustments into a single transaction table, categorizing reason codes for financial reporting and analysis.
Links remittance transactions to specific charges or accounts, providing a detailed view of payments and adjustments at the charge level.
Updates charge-level financial metrics, including payments, adjustments, and denial categories, for accounts identified in the delta table.
Rebuilds the charge measures table by aggregating financial data and denial categories for current charges within the delta set.
Updates the account table with aggregated financial totals, insurance mapping, and primary denial categories for accounts in the delta.
Loads detailed remittance and transaction history, including payment descriptions and payer information, for accounts requiring updates.
Populates a comprehensive account detail table merging patient demographics, provider information, and financial performance metrics for delta accounts.
Loads granular charge-level details, including procedure codes, modifiers, and specific financial balances, for accounts in the delta set.
Records financial transactions, such as payments and adjustments, while establishing chronological posting orders for each account's billing history.
Loads insurance remittance adjustments and denial codes from electronic advice, linking them to specific charges and invoice chains.
Aggregates insurance denial data by category and amount to summarize initial and final remittance adjustments for each account.
Builds financial measures for charges, including payments, adjustments, and denials, while mapping coordination of benefits and denial categories.
Updates the denial category dimension with standardized codes and descriptions to classify and analyze insurance claim rejections.
Calculates and loads detailed financial metrics for charges, including payments, adjustments, and denial categories, using insurance remittance data.
Loads the transaction transformation table by categorizing financial adjustments, denials, and payments for specific patient accounts.
Calculates and loads transaction-based financial measures, including payments, adjustments, and denial categories, for each charge in updated accounts.
Builds a temporary table mapping remittance data to encounters while calculating coordination of benefits and current claim status.
Builds a temporary transaction table by combining payment and adjustment data from remittance records and categorizing them for recovery analysis.
Aggregates transaction data by claim and line item to calculate total payments, adjustments, and denials for recovery reporting.
Summarizes aggregated transactions to compare initial and current payment, denial, and adjustment totals across different coordination of benefits levels.
Categorizes and loads financial transactions, such as payments, adjustments, and denials, while mapping them to specific charges and payers.
Aggregates transaction data to calculate total adjustments, denials, and payments per charge and coordination of benefits level.
Builds the remittance table by mapping transaction data and denial categories for updated accounts in the pipeline.
Updates high-level account metrics, including balances, denial categories, and allowed amount comparisons for the processed accounts.
Populates detailed charge-level information, including procedure codes, modifiers, and payment metrics for accounts requiring updates.
Builds standardized transaction records by mapping source adjustments to specific categories and ordering them for account-level analysis.
Aggregates transaction data into summaries of adjustments, denials, and payments per charge to support account-level financial reporting.
Loads remittance details by formatting transaction descriptions with payer names and standardized adjustment codes for payment tracking.
Builds a comprehensive master record for each account, integrating clinical, financial, and insurance data for detailed reporting.
Builds detailed account charge records by aggregating patient, insurance, and financial data for specific account deltas.
Builds a table of financial metrics for specific charges, calculating adjusted, paid, denied, and patient responsibility amounts.
Refreshes comprehensive account-level details, including provider information, insurance data, and calculated financial balances for the current batch.
Updates detailed charge-level information, including procedure codes, modifiers, and specific financial metrics for accounts in the current delta.
Builds financial metrics for charges, including payments, adjustments, and denials, to track account-level charge performance.
Processes and categorizes financial transactions, such as payments and adjustments, while establishing their chronological order for each account.
Aggregates transaction data into charge-level financial measures, calculating totals for payments, adjustments, and denials by insurance priority.
Aggregates remittance adjustment amounts by type, including contractals and denials, for each charge and payer combination.
Populates the denial category dimension by filtering existing adjustment categories specifically flagged as denials.
Loads transformed transaction data by unpivoting payment and adjustment details for accounts identified as having recent changes.
Updates the transaction transformation table by processing and categorizing electronic remittance advice data for modified accounts.
Loads and categorizes financial transactions, adjustments, and coordination of benefits transfers from the source practice management system.
Calculates financial metrics for individual charges and loads detailed charge records for accounts identified in the current delta.
Aggregates financial totals and denial categories to build account-level records, including insurance mapping and age-based plan logic.
Builds a comprehensive account summary by joining patient, insurance, and financial data to track balances, denials, and estimated opportunities.
Loads granular charge-level details, including procedure codes, modifiers, and provider information, for comprehensive reporting on account financial activity.
Builds a temporary table of charge-level financial metrics, calculating adjusted, paid, patient, and denied amounts for processed accounts.
Updates the account detail table with comprehensive encounter, insurance, and financial summary data for accounts in the current delta.
Populates the account charge detail table with granular service, provider, and financial data for individual charges within processed accounts.
Loads transformed remittance adjustments from electronic remittance advice data, including denial categories and adjustment amounts for specific claims.
Builds an aggregate table of remittance adjustments, identifying initial and current denial categories and amounts for specific account encounters.
Calculates and loads financial metrics, including payments, adjustments, and allowed amounts, into the charge measures table for updated accounts.
Standardizes and cleans raw account data by casting types and parsing facility, insurance, and transaction details into a structured format.
Builds the transaction transformation table by mapping insurance levels and ranking payments and refunds for updated accounts.
Updates charge transaction measures by identifying initial and current denial categories and amounts for updated accounts.
Populates charge transaction measures with detailed financial metrics, including initial and current denial data and allowed dates.
Builds and updates financial metrics for charges, including payments, adjustments, and denials, for accounts with recent activity.
Loads and categorizes financial transactions into payments, adjustments, or denials based on source codes and coordination of benefits.
Calculates and updates aggregated financial metrics, including payments, adjustments, and denials, for accounts identified in the delta tracking table.
Calculates and loads financial metrics including payments, adjustments, and denials for account charges into the charge measures table.
Loads detailed remittance adjustment data from electronic remittance advice records for accounts requiring updates in the current pipeline run.
Aggregates remittance adjustment data to calculate total contract, patient, and denial amounts at the charge level for updated encounters.
Aggregates financial metrics including paid, adjusted, and denied amounts at the charge level to support recovery insights and reporting.
Calculates and updates the coordination of benefits sequence and claim ranking for remittance records.
Builds a temporary table of payment and adjustment transactions by combining remittance line and adjustment data for recovery analysis.
Aggregates transaction data into a temporary table, calculating sums for payments, contracts, patient responsibility, and denials at the claim level.
Summarizes aggregated transaction data to provide total amounts and initial versus current denial categories for each claim and charge match.
Loads calculated financial metrics, including payments, adjustments, and denial categories, into the charge measures table for accounts in the delta.
Updates the account detail table with comprehensive patient, insurance, and financial metrics for reporting and analysis.
Updates granular charge-level details including procedure codes, modifiers, and payment information for individual service line items.
Processes and categorizes remittance adjustments for delta accounts, mapping reason codes to standardized denial and adjustment categories.
Builds aggregated remittance adjustment data by calculating initial and current denial totals and categories for each charge and encounter.
who computes it · 20
Pipelines that compute denial / underpayment
Grouped by product. Each links to its task tree.
the rhythm
When it runs
daily & monthly fires · 19
03691215182124
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daily 03:45
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daily 04:30
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daily 06:30
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daily 06:45
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monthly 07:30
07:30 · 1st
daily 08:30
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daily 09:15
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daily 20:00
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daily 23:00
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chained
runs after the source-data load
HL7 FHIR file/batch eligibility◆ monthly · shaded = overnight (00–06)