SharpInsight — Analytics & Reporting Guide

SharpInsight is ClaimRev's analytics and reporting module. It provides 40+ reports across payment analysis, revenue cycle, denial management, payer intelligence, coding compliance, claims analysis, and MIPS quality tracking.

1. Navigate to SharpInsight from the main menu
2. The landing page shows all available report categories based on your account features
3. Use the sidebar on the left to switch between reports (click the collapse button to maximize the report area)
4. Use the search box at the top of the sidebar to filter reports by name
5. Click the info icon on any report to see a summary, metric definitions, and tips

Reports for tracking payment patterns, detecting underpayments, and measuring time-to-payment.

Compares what was charged versus what was actually paid across payers and time periods. Use this report to spot payers that consistently underpay or overpay relative to billed amounts.

Key Metrics:

Tips:

• Sort by Yield to find the lowest-performing payers quickly.
• Use the drill-down to see individual payment events behind each payer row.

Identifies service lines where the payer paid less than the contracted or expected rate. Helps recover revenue that was legitimately owed but not fully paid.

Key Metrics:

Tips:

• Focus on payers with the highest total underpayment amounts for maximum recovery potential.
• This report requires contracted rates to be configured in the Contracted Rates screen.

Measures how long it takes from claim submission to receiving payment. Tracks turnaround time by payer to identify slow-paying payers and monitor cash flow patterns.

Key Metrics:

Tips:

• Compare Average vs Median — a large gap suggests a few very slow payments are skewing the average.
• Payers consistently exceeding 30 days may warrant follow-up or contract review.

Detects MIPS payment adjustments (CARC 237) in your ERA data. Shows the total dollar impact of CMS penalties or bonuses, broken down by provider and over time.

Key Metrics:

Tips:

• If you see penalties here, the MIPS Quality module can help you track and improve quality reporting to reduce future adjustments.
• MIPS bonuses appear as positive adjustments — use the Provider Scorecard in MIPS Quality to maximize these.

Detects non-MIPS regulatory penalties (CARC 237) in your ERA data, such as NEMA XR-29 CT dose reporting non-compliance.

Key Metrics:

Tips:

• Check the remark code in the Penalty Types table to identify the specific CMS requirement causing the deduction.
• These penalties are separate from MIPS — see the MIPS Payment Impact report for MIPS-specific adjustments.

Reports for monitoring revenue leakage, A/R aging, charge lag, and clean claim rates.

Provides a high-level view of where revenue is being lost in the billing cycle. Compares total billed amounts against collections and breaks down losses by category.

Key Metrics:

Tips:

• A collection rate below 50% typically indicates significant issues with either payer mix, denial rates, or underpayments.
• Compare this report month-over-month to track whether revenue cycle improvements are having an impact.

Shows the age distribution of outstanding accounts receivable. Identifies how long claims have been waiting for payment.

Key Metrics:

Tips:

• Healthy A/R should have the majority of balances in the 0-30 day bucket.
• Claims aging past 90 days are at high risk of becoming uncollectable — prioritize follow-up on these first.

Measures the time between when a service is performed and when the claim is submitted. Long charge lag delays cash flow and can result in timely filing denials.

Key Metrics:

Tips:

• Most payers require claims within 90-180 days of service. Claims lagging beyond that risk timely filing denials.
• Target 95%+ of claims submitted within 7 days of service for optimal cash flow.

Tracks the percentage of claims accepted by the payer on first submission without rejections or errors.

Key Metrics:

Tips:

• Rates below 90% indicate systemic issues in claim preparation that should be addressed.
• Review by payer to identify if specific payer requirements are being missed consistently.

Reports for tracking denial work item outcomes, biller productivity, appeal success rates, and write-off trends.

Measures denial work item throughput per user. Shows how many items each biller worked, resolved, and the revenue recovered through their efforts.

Key Metrics:

Tips:

• Compare Resolution Rate across billers to identify who may need additional training or support.
• High Recovered amounts relative to Denial Amount indicate effective appeal and rebilling strategies.
• Use the monthly trend to track whether team productivity is improving over time.

Breaks down denials by CARC (Claim Adjustment Reason Code) to reveal the most common reasons claims are denied.

Key Metrics:

Tips:

• The top 3-5 denial reasons typically account for the majority of lost revenue.
• CARC codes like CO-4 (modifier issue) and CO-197 (prior auth) often point to correctable front-end problems.

Tracks denied amounts that were written off versus recovered through appeals or resubmission.

Key Metrics:

Tips:

• A high write-off rate may indicate that appeals are not being pursued consistently.
• Track recovery rate trends monthly to measure the impact of process improvements.

Measures the success rate of claim appeals by payer and over time.

Key Metrics:

Tips:

• 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.

Reports for evaluating payer performance, detecting anomalies, and tracking acceptance rates.

High-level overview of claim volume, payments, and adjustments for each payer. A good starting point for understanding your payer mix.

Comprehensive performance comparison across all payers. Combines payment speed, collection yield, denial rates, and volume into a single comparative view.

Key Metrics:

Tips:

• Use this report for annual payer contract negotiations — data-driven conversations lead to better terms.
• Sort by different columns to identify payers that are problematic in specific areas.

Automatically detects unusual changes in payer behavior by comparing recent activity against historical baselines.

Key Metrics:

Tips:

• Negative payment deviations may indicate a payer has changed their fee schedule or processing rules.
• Sudden spikes in denial rates often correspond to payer policy changes or system updates.

Tracks the percentage of claims accepted by each payer after submission.

Key Metrics:

Tips:

• Rates below 90% for any payer warrant investigation into common rejection reasons.
• Compare against the Clean Claim Rate report to distinguish submission errors from payer-side rejections.

Reports for tracking procedure code changes, CARC trends, profitability, and contracted rates.

Identifies claims where the payer adjudicated a different procedure code than what was originally submitted. This may indicate downcoding, bundling, or legitimate code corrections.

Key Metrics:

Tips:

• Frequent downcoding (higher code changed to lower) by a specific payer may indicate aggressive payment policies.
• Some code changes are legitimate corrections — focus on patterns rather than individual occurrences.

Tracks Claim Adjustment Reason Code (CARC) volumes and dollar amounts over time. Shows whether specific adjustment reasons are increasing or decreasing.

Key Metrics:

Tips:

• Watch for CARC codes that are trending upward month-over-month — they may indicate new payer rules or process breakdowns.
• Cross-reference with the Denial Root Cause report for a complete picture of adjustment impacts.

Analyzes the financial performance of each procedure code by comparing charges, payments, and costs.

Key Metrics:

Tips:

• Procedures with high volume but low margin may benefit from contract renegotiation.
• High denial rates on specific procedures often point to documentation or coding education opportunities.

Manages the expected payment rates for each payer and procedure code. These contracted rates are used by other SharpInsight reports (like Underpayment Detection) to calculate payment variances.

Key Metrics:

Tips:

• 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.

Reports for analyzing claim touch points, status code outcomes, and similar claims.

Tracks how many times a claim is touched (submitted, corrected, resubmitted, appealed) before final resolution. Higher touch counts indicate process inefficiency.

Key Metrics:

Tips:

• Industry benchmark for first-pass resolution is 90%+. Below 80% suggests significant rework issues.
• Claims with 3+ touches should be reviewed to identify common root causes of rework.

Shows the final financial outcomes grouped by claim status codes.

Key Metrics:

Tips:

• Status codes with low payment rates may indicate specific payer processing issues.
• Use alongside Denial Root Cause for a complete view of claim adjudication outcomes.

Uses AI to find claims similar to a selected claim based on diagnosis codes, procedure codes, payer, and other attributes. Useful for researching how similar claims were adjudicated.

Key Metrics:

Tips:

• 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.

Reports for MIPS quality measure performance, gap analysis, and provider scorecards.

Shows estimated MIPS composite quality score, per-measure performance rates, and projected Medicare Part B payment adjustment.

Key Metrics:

Tips:

• Focus on high-priority measures first — they carry more weight in the composite score.
• Export the quality summary CSV for submission preparation or internal review.

Breaks down quality code gaps by measure and by provider to identify where gaps are concentrated.

Key Metrics:

Tips:

• High pending counts for a single measure may indicate a systematic documentation issue.
• Use the Gap Review Queue to work through pending alerts.

Compares quality performance across individual providers (NPIs).

Key Metrics:

Tips:

• Providers with low capture rates may benefit from quality code documentation education.
• Sort by capture rate to quickly identify providers who need the most improvement.

Tracks quality code capture rate over time with monthly trends.

Key Metrics:

Tips:

• A declining trend may indicate new measures were added without proper provider training.
• Monthly detail helps identify seasonal patterns in quality code capture.

Lists all pending quality code gap alerts awaiting provider review. Use this queue to systematically work through gaps.

Key Metrics:

Tips:

• Work through the queue regularly to ensure gaps are addressed before the end of the performance year.
• Click on a row to navigate to the claim detail MIPS tab for confirm/dismiss actions.

Manages which MIPS quality measures are active for your account.

Key Metrics:

Tips:

• Import CMS measures at the start of each performance year to get updated measure definitions.
• Toggle measures off if they are not relevant to your practice specialty.

Click the gear icon in the sidebar header to access SharpInsight configuration settings. Settings include:

• Variance thresholds — Configure the dollar amount and percentage thresholds used by the Underpayment Detection report
• Similarity settings — Set the minimum similarity score and maximum results for the Claim Similarity report
• CARC exclusions — Exclude specific CARC codes from trending and analysis
• Denial settings — Configure write-off threshold days and appeal detection behavior

Need help? Contact ClaimRev support at help@claimrev.com or call 918-842-9564.