New Case Intake
HIPAA Compliant
PRE-BILL
Encounter Identification
Core identifiers for this audit case. All required fields must be completed before analysis can run.
Patient & Encounter
Review Mode
Pre-Bill (Concurrent)
Post-Bill (Retrospective)
Appeal Support
Compliance Spot Check
DRG & Diagnosis Coding
Current coding assignment and diagnosis information for audit analysis.
Current DRG Assignment
Principal & Secondary Diagnoses
Procedures (ICD-10-PCS / CPT)
Chart & Document Upload
Upload clinical documentation for analysis. All formats accepted. Documents are encrypted on upload.
Drop files here or click to browse
Supports batch upload — multiple files per encounter
FHIRHL7PDF
DOCXTXTTIFFPNGJSON
Document Type Checklist
EHR Direct Integration
Payer & Reimbursement
Payer configuration drives denial risk scoring and reimbursement impact estimates.
Payer Information
Overrides relative weight calculation with actual contract rate
RAC / External Audit Status
| Audit Target Area | Status | Risk Level |
|---|---|---|
| MS-DRG 291 (HF w/ MCC) | Active RAC Target | HIGH |
| Cardiac Device Implants | OIG Work Plan | MED |
| Short-Stay Inpatient | Monitoring | LOW |
Audit Engine Configuration
Configure which audit checks run and set confidence thresholds for this case.
Audit Focus Areas
CC/MCC Capture
Principal Dx Validation
DRG Optimization
Denial Risk Scoring
HAC/PSI Check
POA Validation
Procedure Mismatch
Laterality Review
Upcoding Risk
Confidence Thresholds
Himio Engine Settings
Rules + Himio Hybrid Mode
Combines deterministic rules with Himio's text analysis
Payer-Specific Rules Engine
Apply MAC/LCD/NCD policy checks for selected payer
HAC/PSI Quality Penalty Cross-Check
Flag code combinations that trigger CMS quality penalties
Concurrent CDI Alerts
Trigger real-time CDI alerts during active admission
Review Workflow & Role Assignment
Assign reviewers and configure the human-in-the-loop workflow for this case.
Assign Review Roles
Lead Auditor
Primary reviewer — can approve, reject, or escalate all findings
CDI Specialist
Reviews documentation gaps and generates physician queries
Physician Advisor
Level 2 clinical validation and appeal sign-off authority
Compliance Officer
Read-only access with export and audit log review rights
SLA & Deadlines
Case Notes
Review & Submit
Confirm case details before submitting for analysis. All inputs are editable after submission.
Encounter
—
Current DRG
—
Payer
Medicare (Traditional)
J5 — Wisconsin Physicians
J5 — Wisconsin Physicians
Audit Focus
4 checks selected
Hybrid Himio + Rules mode
Hybrid Himio + Rules mode
Documents
2 uploaded
Discharge Summary · Op Report
Discharge Summary · Op Report
RAC Status
Active RAC Target
MS-DRG 291 — High risk
MS-DRG 291 — High risk
Submit the case to run analysis.