Revenue Cycle Intelligence · IR-DRG v3.5 · in-browser

Test the severity gap your audit may miss.

ClaimAct reviews an agreed historical inpatient claim set and asks which encounters merit human CDI review. The 3–8% range shown here is an illustrative model assumption, not an observed result or a recovery promise. The pilot tests the model against your scoped data and returns the findings for your team to review.

Start the AED 7,500 pilot View synthetic sample report

3–8%illustrative model range · not a finding or recovery forecast
525ruleset entries in the current IR-DRG v3.5 library
30 daysone-time pilot · no automatic subscription

SYNTHETIC INPATIENT CLAIM ENC-018342

DRG054121

LOS8d

PaidAED 13,500

PayerThiqa

SEVERITY · CAPTURED vs MODEL CANDIDATE

CAPTURED tier 1

MODEL CANDIDATE tier 3

LEAKAGE TABLE · SYNTHETIC SAMPLE MODELLED 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 review hypothesis from four angles. Each role sees the slice that maps to the decision they own. Local preview processing does not transmit the file; your team still decides whether and how to share any export under its own policies.

RCM DIRECTOR

Portfolio exposure at a glance

Aggregated model candidates by payer, service line, and quarter. Use the view to decide where human review starts; it does not state booked or recoverable revenue.

CODER

Claim by claim, gap by gap

Every flagged encounter with the DRG that was billed, the model candidate, and a review reason. The candidate is a prompt for human review, not a coding decision.

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 modelled review amount per quarter, clearly separated from booked or recovered revenue. Your team decides which candidates survive clinical, coding, and compliance review.

Four modules

Each angle on the same severity gap.

MODULE 01

Shadow Leakage Audit

Walks each scoped historical claim against the ruleset. Surfaces candidate encounters for human review and ranks them by modelled dirham impact; it does not determine what documentation supports.

MODULE 02

EMV Dispatch

Expected Mean Value queue for the coding team. Routes flagged claims by modelled value and review effort, not by submission date. Values are prioritisation aids, not recovery forecasts.

MODULE 03

HTLOS Outlier Monitor

High Trim Length of Stay anomalies. Flags encounters that crossed the modelled trim point for human review; it does not determine billing eligibility or recovery.

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.

One bounded first step

The report comes before the subscription decision.

The only public paid offer is a one-time 30-day pilot on one agreed historical claim set. We agree the scope and data agreement before any claim data is transferred. ClaimAct then delivers a findings report and workflow demonstration before we ask whether you want to continue.

Available now · one-time pilot

AED 7,500 once

Thirty days on an agreed historical claim set. No auto-renewal and no subscription starts from the pilot checkout.

Written scope and data agreement before data transfer
Findings report plus workflow demonstration
Hospital retains every coding, clinical, and compliance decision

Post-pilot anchor · not a checkout

AED 7,500/mo

Standard recurring access may be offered only after the pilot findings report is delivered and received. It requires a new, explicit opt-in.

Post-pilot anchor · not a checkout

AED 15,000/mo

Enterprise recurring access is a separate decision after delivered findings. It never starts automatically from the pilot.

How the data flows

Your claims, your machine, your call.

ClaimAct's local preview engine and current 525-entry ruleset run in the browser tab. A paid pilot starts only after the historical claim-set scope and data agreement are agreed. No claim file should be transferred to us before that gate is complete.

Agree scope and data terms

Define the historical claim set, required fields, transfer method, review boundary, and data agreement first. Do not transfer claim data before this step is complete.

Run the agreed historical set

Each scoped claim is scored against the current IR-DRG v3.5 ruleset and its DRG-family model. Output remains a review queue, not a final coding or recovery decision.

Review the four modules

Shadow Leakage, EMV Dispatch, HTLOS Monitor, and Portfolio Scanner form the workflow demonstration. Your team reviews model candidates and their stated limitations.

Receive the findings report

The pilot closes with the findings report and workflow demonstration. Only after delivery may we offer recurring access; continuing requires a separate explicit opt-in.

Start with one agreed historical claim set.

AED 7,500 once for a 30-day pilot. Scope and data agreement come before data transfer. You receive the findings report before any subscription ask. The pilot never auto-renews.