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--- guides:sharpinsight [2026/06/18 17:33] – Standardize support contact to help@claimrev.com / 918-842-9564 brad.sharp
+++ guides:sharpinsight [2026/07/24 19:48] (current) – Add Worked & Resubmitted, Diagnosis Ordering Impact, and AI Rule Suggestions reports brad.sharp
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   * Payers with win rates above 50% are strong candidates for consistent appeal efforts.
   * If appeal rates are low but win rates are high, you may be leaving recoverable revenue on the table.
+==== AI Rule Suggestions ====
+Groups your denials into patterns by reason code, payer, and procedure code, then lets you ask AI to analyze any pattern and suggest how to resolve and prevent it. For each pattern the AI explains what is likely happening, lists possible causes and recommended actions, and where appropriate recommends an automated rule to stop the denial from recurring.
+**Key Metrics:**
+^ Metric ^ Description ^
+| Denial Patterns Found | The number of distinct reason-code + payer + procedure denial patterns in the selected period. |
+| Total Denial Amount | The combined dollar amount of all denials analyzed. |
+| Total Service Lines | The number of denied service lines behind the patterns. |
+| Denial Code | The CARC group and reason code (e.g., CO-197) shown with its description. |
+| Top CPT Codes | The procedure codes most frequently denied within each pattern. |
+**Tips:**
+  * Click **Analyze** on a pattern to generate AI suggestions. These are a starting point — confirm against the claim detail or with the payer before acting.
+  * When the AI recommends an automated rule, it shows a confidence score and pre-fills values from the denial data so you can prevent the pattern going forward.
+  * Start with the highest Total Amount patterns for the biggest recovery and prevention impact.
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   * Keep contracted rates up to date to ensure accurate underpayment detection.
   * If a payer uses a Medicare multiplier, you only need one entry rather than individual procedure rates.
+==== Diagnosis Ordering Impact ====
+Finds cases where the same payer reimburses the same CPT code differently depending on the order the diagnosis codes are listed. When claims share a payer, a CPT code, and the same set of diagnosis codes but list them in a different order, the payer may pay them differently. This report surfaces those groups and shows which ordering pays best.
+**Key Metrics:**
+^ Metric ^ Description ^
+| Groups with Impact | The number of payer + CPT + diagnosis-set groups where the ordering changed the payment. |
+| Max Payment Variance | The largest average payment difference between the best and worst ordering across all groups. |
+| Estimated Recoverable | The total dollar opportunity if every claim had used the best ordering. |
+| Best / Worst Avg Pay | The average payment for the highest- and lowest-paying ordering in a group. |
+| Variance % | The percentage payment difference between the best and worst ordering. |
+**Tips:**
+  * Expand any group to compare orderings side by side. The row marked **Best** is the ordering to train billers to use for that payer + CPT combination — list that primary diagnosis first.
+  * Use **Min Claims per Ordering** to require more claims before an ordering appears (higher = more reliable), and **Min Variance %** to hide differences too small to act on.
+  * Click an ordering to drill into the underlying claims, then open the claim editor or ERA directly.
+  * Use **Create Rule** to turn a best-ordering finding into an automated rule.
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   * Use this to research appeal strategy — find similar claims that were successfully paid after initial denial.
   * High similarity scores (90%+) provide the most reliable comparison data.
+==== Worked & Resubmitted ====
+Shows claims that were submitted or resubmitted within a date window and whether that work led to payment, denial, or rejection. Every revision of a claim is grouped into a single "claim family" so you can see the full submit-and-rework path and its final outcome. A direct way to measure whether follow-up effort is actually converting to paid claims.
+**Key Metrics:**
+^ Metric ^ Description ^
+| Claims Worked | The number of distinct claims submitted or resubmitted in the selected window. |
+| Resubmissions | The number of send events that were resubmissions of a claim sent previously. |
+| Paid / Denied / Rejected | The count and percentage of worked claims that ended in each outcome. |
+| Awaiting | Worked claims that have not yet reached a final outcome. |
+| Dollars Paid | Total payments received on claims worked in the window. |
+**Tips:**
+  * Use the By Payer table to see which payers reward resubmission effort and which keep denying.
+  * Click any claim family to expand its full revision path — received, sent, status, payer acceptance, advice, and outcome for each revision.
+  * A high resubmission count with a low paid percentage points to rework that is not fixing the underlying denial reason — cross-reference the **Denial Root Cause** report.
+  * Export to CSV to build follow-up worklists.
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