RCM DIRECTOR
Portfolio exposure at a glance
Aggregated leakage by payer, service line, and quarter. The dashboard your CFO actually reads. Identify which clinical units are leaving the most severity on the table.
Revenue Cycle Intelligence · IR-DRG v3.5 · in-browser
The three to eight percent your audit can't see.
ClaimAct reads every inpatient claim leaving the hospital and asks a single question: did this capture the full severity of what actually happened? Most don't. Across a fifty thousand claim year, the gap is typically three to eight percent of gross revenue, and it is invisible to compliance audits by design.
- 3–8%gross revenue captured by closing the severity gap
- 525IR-DRG denial library codes · v3.5 effective Nov 2025
- 0claim records leave the device · all processing in-browser
INPATIENT CLAIM
ENC-018342
DRG054121
LOS8d
PaidAED 13,500
PayerThiqa
SEVERITY · CAPTURED vs ACTUAL
LEAKAGE TABLE · TOP GAPS
AED 142,300
ENC-018342+ AED 18,400
ENC-019104+ AED 12,250
ENC-019287+ AED 9,800
Who reads the leakage table
Four operators, one source of truth.
ClaimAct surfaces the same gap from four angles. Each role sees the slice that maps to the decision they own. No PHI leaves the browser, so the same export can be shared across the table without a privacy review.
CODER
Claim by claim, gap by gap
Every flagged encounter with the DRG that was billed, the DRG the consensus engine expected, and a precise reason. Audit your own work without waiting for a denial.
COMPLIANCE LEAD
Defensible severity logic
525 code IR-DRG denial library with the exact Shafafiya rule cited for each flag. Trace any decision back to its source. No black box, no surprise findings.
CFO
The dirham value of accuracy
A single number per quarter. The revenue that should have been captured if every claim left the hospital at the right severity tier. Sized against gross and net.
Four modules
Each angle on the same severity gap.
MODULE 01
Shadow Leakage Audit
Walks every paid claim against the consensus DRG. Surfaces the encounters where the captured severity is materially below what the documentation supports. Ranked by dirham impact.
MODULE 02
EMV Dispatch
Expected Mean Value queue for the coding team. Routes flagged claims by recovery probability and effort, not by submission date. Two hours of coder time captures the high-value tail.
MODULE 03
HTLOS Outlier Monitor
High Trim Length of Stay anomalies. Catches the encounters that exceeded the DRG trim point but were never escalated to outlier billing. Recovers severity the audit floor structurally misses.
MODULE 04
Portfolio Exposure Scanner
Cross sectional view across payers and service lines. Tells the RCM director which clinical units, which payers, and which quarters carry the most unrealised severity. Print to PDF for the board pack.
How the data flows
Your claims, your machine, your call.
ClaimAct is a single page web app. The consensus engine, the 525 code denial library, and every module run entirely in the browser tab. We do not host your claims data, we never see it, and we do not need to.
01
Drop the CSV
Export from Oracle Cerner, Medisoft, or any HIS that produces a flat claims file. ClaimAct auto maps the columns. Sample dataset available if you want to test the pattern before exporting.
02
Consensus engine runs locally
Every claim is scored against the IR-DRG v3.5 ruleset and the cohort distribution for that DRG family. No network call, no upload, no server. Audit complete on a fifty thousand claim file in under a minute.
03
Review the four modules
Shadow Leakage, EMV Dispatch, HTLOS Monitor, Portfolio Scanner. Toggle between them. Each module reads the same in-memory claims set. Close the tab when you are done.
04
Export the action list
Download the prioritised encounter list as CSV for the coding team, or the executive summary as PDF for the CFO. Nothing leaves the device unless you press download.
Run your last quarter through it.
Free during active development. No login, no upload, no contract. If the leakage number lands above the audit floor, we should talk about why. Bring a CSV or load the fifty claim sample.
ClaimAct is built for inpatient revenue cycle teams operating under DOH Shafafiya IR-DRG v3.5 (effective November 2025). The audit logic is portable to other DRG regimes on request. Claim data never leaves the device. We are a small team in Abu Dhabi and we work directly with the people running the queue.