Revenue Cycle Dashboard
Real-time snapshot for BHW Medical Group from the shared Google Cloud ledgers and Stedi clearinghouse feeds.
Charges vs. Collections
Claim Status Mix
A/R Aging
Collections by Payer
Priority Worklist
Charges & Claim Upload
Import claim details, capture charges, and follow every claim from draft through payment. Google Cloud is the only claims ledger; Stedi adds claim-status and remittance updates when linked.
Claim Ledger
Waiting for claims| Invoice / claim # | Patient | Patient ID | DOS | Payer | Program | CPT | Billed | Provider | Status | Source |
|---|
Payments & Posting
Electronic remittances come directly from Stedi. Paper payer EOBs and patient payments are saved to the protected Google Cloud payment ledger; matching records are counted only once.
Scan or Upload an EOB
No portal 835 is required. This reader can identify the payer, payment date, check/EFT reference, claim, patient, and visible payment-column amounts from a paper EOP. Every OCR-derived amount must be checked against the document before posting; nothing posts from this upload automatically.
Best result: scan one page at a time, upright and flat, at 300 dpi or higher; crop to the page edges and avoid a desk, laptop, shadows, or angled phone photo in the background. A clean payer PDF is also supported when available.
Post a Payment / EOB
Collections Trend
Stedi 835 + Google Cloud manualPayment Source Split
Payments & EOB ledger — deduped
| Payment date | Date of service | Claim # / Batch | Patient | Payer | Check/EFT # | Amount | Source | Method | Status |
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Stedi 835 Remittance Details
⚑ Downcoding Watch
| Claim # | Payer | Billed | Paid As | Program | $ Lost | Pattern |
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Electronic Remittances (835)
| Payer | ERA # | Check / EFT | Date | Amount | Claims | Posting |
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Adjustment Reasons
Denials & Rejections
One live work queue for clearinghouse rejections and payer denials. Correction work stays separate from payer appeals, and deadlines appear only when they are confirmed from the payer notice.
Open Items by Work Type
Open Items by Payer
Correction vs. Appeal Triage
| Work type | What it means | First action | Resolution path |
|---|---|---|---|
| Clearinghouse rejection | The payer has not accepted the claim for adjudication. | Correct subscriber, provider, coding, or format data and resubmit. | Confirm a new 277CA acceptance; this is not an appeal. |
| Eligibility / COB | Coverage, member data, or payer order did not match the service date. | Recheck eligibility/COB and compare the claim to the payer-confirmed data. | Correct and resubmit, or appeal only with coverage/order evidence. |
| Authorization / medical necessity | The payer needs authorization or clinical-policy support. | Verify the authorization and policy, then assemble the relevant clinical record. | Use the exact reconsideration, peer-review, or appeal instructions on the notice. |
| Coding / duplicate / timely filing | The payer rejected claim construction, duplication, or receipt timing. | Compare the original accepted claim, codes, payer control number, and submission proof. | Correct/reopen when appropriate; appeal only when the adjudication is factually wrong. |
Denial Worklist
| Claim / source | Patient / payer | Reason | $ at risk | Received / age | Confirmed deadline | Owner | Status | Next action |
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Reconciliation
Two levels: claim-by-claim reconciliation (billed → allowed → paid → patient balance) and payer deposit matching. Every posted payment — electronic 835 or a manual EOB / patient payment — reconciles the claim automatically.
Claim-Level Reconciliation
| Claim # | Patient | Program | Provider | Payer | Billed | Allowed | Paid | Adj | Pt Resp | Balance | Status | Bank deposited to | Deposit date | Done |
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Reconciliation Worksheet — July
| Source | Expected | Received | Variance | Status |
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Charge Master (CDM)
The shared CPT/HCPCS catalog across Primary Care, M&M, Population Health, CharmEd Minds, and Flow. The read-only public benchmark covers all 137 BHW codes using CMS 2026 PFREV26A–D, non-QP carrier 12302/locality 01: 108 codes have Baltimore MPFS amounts and 29 are explicitly not priced by MPFS. Protected BHW standard charges and contracted allowables require an authoritative source and Cloud read-back; blanks remain rate not set, never $0.
Fee Schedule
Google Cloud · connecting| CPT/HCPCS | Description | Program | MUE | Bundles | Charge | Medicare Allow. | BCBS MD Allow. |
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Insurance Verification
Real-time eligibility and coordination of benefits through Stedi.
Run Eligibility Check (270)
Eligibility Response (271)
Waiting for live checkRun a check to see service-specific coverage, copay, coinsurance, deductible, network, limits, messages, and prior-auth requirements. On success it is saved to the protected Google Cloud insurance ledger.
Coordination of Benefits (COB)
Choose a payer and complete a successful eligibility check first. The button becomes available when Stedi supports COB and the payer confirms the subscriber details.
Annual Wellness Visit (AWV) — Medicare
Verify AWV timing against claims or the MAC before billing.
| Patient | Coverage | Last AWV | Next Eligible | Status | Recommended |
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Recent Verifications
Waiting for Stedi / Google Cloud| Patient | Payer | Plan | Copay | Deductible Left | Verified | Status |
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Payer Contracts
The protected BHW contract register records source evidence and reimbursement methodology separately from exact code-level allowables. Formula-only terms never become dollar rates.
Contract Evidence Register
| Payer / Contract | Product / Type | Effective | Renewal | Rate evidence | Status |
|---|
Automatic Insights
These findings calculate from the same live claims, payments, Stedi, and reconciliation data as the weekly summary. No prompt is required.
Weekly Summary
Live from your claims, collections, and denials — week of —. Wins and watch-list update themselves as the numbers move.
Wins
Watch List
The Books
Bookkeeping & bank reconciliation. Deposits auto-match to the payments you’ve recorded, every line gets a category, and you split it to a program — so your P&L and each program’s budget stay accurate. Connect the bank once and it syncs on its own.
Accounts
by program| Account | Institution | Balance |
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By Program
net this period| Program | In | Out | Net |
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By Category
this period| Category | Amount |
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Ledger
| Date | Description | Account | Category | Program | Amount | Reconciled |
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Budgets
Shared annual program targets alongside actual revenue and expenses from The Books.
Budget vs. Actual by Program
The Books + attributed claims| Program | Revenue Target | Revenue Actual | Expense Budget | Expense Actual | Status |
|---|
Potential Goals for Next Quarter
Draft from current live baselineRevenue Health
The whole income picture beyond fee-for-service claims — non-claim revenue, money going back out, and the metrics that tie it together.
Post Non-Claim Revenue
| Date | Source | Description | Stream | Amount |
|---|
Refunds / Recoupments / Credit Balances
money outTrack identified overpayments through timely resolution.
| Date | Party | Reason | Type | Amount |
|---|
Payer Mix
Provider Profitability
Revenue, cost, and margin by provider — the view Flychain lists as “coming soon,” built on the provider tags you already capture on every claim.
Revenue vs. Compensation by Provider
Provider P&L
| Provider | Lines | Revenue | Comp (annual) | Margin | Margin % |
|---|
Revenue by Provider × Program
the breakdown you asked forRate Benchmarking
Your allowed rate per CPT vs. Medicare and the MD Medicaid floor — seeded with your real BHW code set and the live Maryland Medicaid fee schedule (1.1.26). Enter your contracted allowed + Medicare per code to see where you’re underpaid.
Your Rate vs. Medicare vs. MD Medicaid
Rate Detail
| CPT | Service | Program | Vol | Your Allowed | Medicare | MD Medicaid | Gap vs Mcr | Flag |
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Industry Benchmarks
How BHW compares to physician practices under $5M — NAICS 621111. Benchmark figures are from your industry report; your actuals compute from the P&L as real data flows in.
Profit Margins
higher is betterSpending (% of revenue)
lower is betterKey Industry Metrics
| Metric | Industry | Comparison |
|---|
Liquidity & Cash
Known Industry Risks & What To Do
from your NAICS 621111 reportRevenue Opportunity
Money on the table right now — underpayments, denials, patient balances, and unbilled work — pulled together from across the dashboard, each with the action to capture it.
Opportunities by Category
| Opportunity | Est. $ | Basis | How to capture |
|---|
Capture Gaps
| Missed code | Service | Captured | Eligible | Gap | $ Missed | Note |
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Recurring Revenue You May Be Leaving
| Code | Service | Medicare (QPP) | Why it's missed / how to capture |
|---|
Tax Planning
The tax levers healthcare small-business owners most often leave on the table — including the ones most tools skip. Educational, not tax advice — validate each with your CPA.
Planning estimates only; confirm tax decisions with BHW’s CPA.
AI CFO
Plain-English answers over your financials, with the KPIs a CFO watches. Ask anything, or start from a prompt.
Ask your AI CFO
Weekly Goal Tracker
Billing throughput against target for the current trailing 7 days.
Charges Billed
Goal $20,000Claims Submitted
Goal 120Clean Claim Rate
Goal 90%Open Denials
Goal 0Reconciled
Goal 100%Daily Billing Pace
Live · Google Cloud claimsCPT by Program
Procedure volume and revenue by clinical program. Filter to one program, or see them all.
Revenue by Program
Top CPT Codes by Volume
CPT Performance
Live · reconciled Google Cloud claims| CPT | Description | Program | Volume | Revenue | Avg Reimb. |
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Claims Log
Chronological billing log from the shared Google Cloud claims ledger.
| Date | Claim # | Patient | Program | CPT | Amount | Payer | Status | Provider |
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P&L by Program
Revenue, cost, and margin by program — quarter to date.
Revenue vs. Cost by Program
Margin by Program
| Program | Revenue | Direct Cost | Margin $ | Margin % |
|---|
Expense Logging
Operating expenses by category and program — QTD. Tagging an expense to a program flows straight into P&L by Program.
Expense Mix
Category Totals (QTD)
The Books · no activity| Category | Amount | % of Total |
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Cost by Program
→ P&L| Program | Direct Cost |
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BHW EduMedia
Content production and revenue for BHW EduMedia.
Revenue by Content Type
Production Pipeline
No source connected| Title | Format | Status | Publish Date | Revenue |
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Program
Annual Budget
Budget vs. Actual (YTD)
—Revenue
YTD attributedDirect Expenses
tagged to this program| Item | Category | Amount |
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Forecast
A living 12-month projection — like LivePlan, but fed by your real run-rate. Set the growth assumptions and it recalculates revenue, expenses, net, and cash on hand, month by month.
Assumptions
12-Month Projection
Month-by-Month
| Month | Revenue | Expenses | Net | Cash on Hand |
|---|
Q3 Goals vs. Actual — by Program
Quarter-to-date revenue pacing against Q3 2026 targets for each program. Updates as claim + non-claim revenue is attributed.
Revenue Goal vs. Actual by Program ($K)
| Program | Q3 Goal | Actual (QTD) | % of Goal | Status |
|---|
Payment Recovery Timeline
The BHW 5-phase recovery process — from front-end prevention to final write-off decisions. Each phase has day-by-day action steps and an AI assist.
Phase 1 — Prevention (front-end)
Before / day of service- Run Stedi eligibility (270/271) at scheduling and again at check-in; capture copay, deductible, and prior-auth flags.
- Confirm prior authorization for any service that requires it (watch Aetna EOB 323 patterns).
- Verify demographics, subscriber ID, and coordination-of-benefits order.
- Collect patient responsibility (copay/estimate) at point of service.
Phase 2 — Clean Submission
Day 0–3- Scrub claim for CPT/ICD match, modifiers, and units before release.
- Submit via Inovalon clearinghouse; confirm acceptance (277CA) within 48h.
- Resolve front-end rejections same day — do not let them age.
- Log submission timestamp to protect against timely-filing (EOB 528).
Phase 3 — Follow-Up
Day 4–30- Day 7: status-check any claim without acknowledgment.
- Day 14: work first denials/rejections; post all ERAs within 48h of receipt.
- Day 21: escalate no-response claims to payer rep; document reference #.
- Day 30: flag anything unpaid into the appeal queue.
Phase 4 — Appeal & Escalation
Day 31–90- Draft appeal citing the specific Maryland EOB code and medical-necessity basis (439, 323, 539, 528).
- Aetna: request peer-to-peer within the 30-day window for auth denials.
- Medicare: pursue reopening/redetermination via Novitas.
- Maryland Medicaid MCO: file good-cause exception for timely-filing.
- Track appeal deadlines; second-level appeal where first is upheld.
Phase 5 — Write-Off Decision
Day 90+- Review remaining balance against cost-to-collect threshold.
- Confirm all appeal levels exhausted and deadlines passed.
- Route patient-responsibility balances to statements / payment plan before write-off.
- Document write-off reason and obtain sign-off; feed pattern back to Phase 1 prevention.
Insurance Discovery
Find active coverage you didn’t know about from just patient demographics — no member ID needed. Turns self-pay / uninsured visits into billable claims and surfaces hidden secondary coverage.
Run Discovery
Discovery Result
Waiting for live searchRun a discovery to find active coverage. Any coverage found can be sent straight to Eligibility to confirm benefits, then billed.
Recent Discoveries
Self-pay coverage found → convert to billable| Patient | DOB | Discovered Payer | Member ID | Plan | Est. $ | Result |
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Claim Status 276 / 277
Select one payer-accepted claim from Google Cloud, confirm the subscriber details, and request its current status from Stedi.
Choose a claim
277 Response
No request sentThe payer’s status, effective date, payer claim number, and payment details will appear here. A response can contain more than one matching claim.
All Google Cloud Claims
| Claim # | Patient | Payer | DOS | Current state | Destination | Live 276 |
|---|---|---|---|---|---|---|
| Waiting for Google Cloud claims… | ||||||
Claims checked this session
Stedi 277| Claim # | Patient | Payer | Submitted | 277 Status | Charge | Age | Category |
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Claim Laundering E/M clean-claim scrub
Pre-bill edits that catch what a payer would deny or downcode — before the claim goes out. Curated to your E/M coding and payers, tuned for actual reimbursement, not just first-pass acceptance.
Flagged $ by Payer
Findings by Severity
Pre-Bill Scrub Queue
| Claim # | Patient | Payer | E/M | Findings | Top fix | Charge | Status |
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Rule Library
E/M · curated| Rule | Type | Scope | Severity | Source |
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Suggested from your denials
Medicare Preventive Frequencies
| Code | Limit | Notes |
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Money Watch Charges + 277A + 835 + reconciliation
Claims the payer acknowledged but for which no 835 has returned, linked back to the charge/claim ledger and deposit reconciliation.
$ at Risk by Payer
Deadline Buckets
Money Watch Worklist
acknowledged · no 835 · sorted by days left| Claim # | Patient | Payer | Acknowledged (277) | Days No-835 | Filing Limit | Days Left | $ at Risk | Priority |
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Payers & Enrollment
Stedi’s payer directory and your transaction enrollment status per payer — which payers are live for eligibility, claims, and ERA.
Payer Enrollment Matrix
Stedi payer directory| Payer | Stedi Payer ID | Eligibility | Claims | ERA (835) | Status |
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Population Health Management
Managing the whole attributed panel — risk, care gaps, chronic disease, hospital transitions, BHI/CoCM, and value-based revenue.
Risk Stratification
Value-Based Revenue at Stake
Chronic Conditions
Care Gaps by Measure
Rising-Risk Worklist
Care Gaps & Chronic Registry
Care Management is the primary list. Medicare claims and payer files enrich it; CRISP is not used as the care-gap source.
Open Gaps by Measure
Chronic Disease Registry
Care Management| Condition | Patients | Controlled | CCM Eligible | Enrolled |
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Care Gap Worklist
Care Management + payer files| Patient | Measure | Last Done | Due | Program | Status |
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Hospital Visits & Transitional Care
Admissions, discharges, and ED visits across your panel (CRISP ADT feed) — surfaced so no discharge slips past the TCM window. Post-discharge follow-up is better care and billable (99495/99496).
ADT & TCM Worklist
CRISP CEND · TCM clock| Patient | Event | Facility | Date | Primary Diagnosis | Chief Complaint | Disposition | TCM Window (computed) | Action |
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Quality & MIPS
The scorecard for measured performance. It stays unscored until validated patient-level measure data is connected.
Category Performance vs. Benchmark
Composite Weighting
Quality Measures
Awaiting validated source| Measure | Type | Performance | Benchmark (decile) | Points | Status |
|---|
Participation Status & The Decision
PY 2026- Participation status: Not verified. Check each clinician and the group in the current CMS QPP Participation Status tool before choosing a reporting path.
- Practice roster: Not connected. Import or verify the current TIN/NPI roster before calculating eligibility.
- Special status: Not verified. Small-practice, HPSA, hardship, and category-reweighting status must come from CMS or approved evidence.
- Reporting path: Not selected. The MIPS Manager should record the final individual/group choice, measures, owners, evidence, and submission confirmation.
Deadlines & Milestones
Refresh dates and scoring rules from CMS for the selected year.
MIPS Resources — Downloads
TeamWorking files for the MIPS 2026 opt-in + Flow vascular screening rollout.
Sources & Method
What this dashboard is built on — Google Cloud ledgers, Stedi transactions, CRISP hospital alerts, Care Management, payer/CMS files, and the standards behind each section. Unavailable sources remain empty.
Data & Integrations
- Stedi — clearinghouse & healthcare APIs (eligibility 270/271, insurance discovery, claim status 276/277, remittance 835, payer directory / enrollment). Live feeds source directly from Stedi.
stedi.com/docs Public OpenAPI specs - Google Cloud — shared system of record for the Patient Registry, claims, insurance results, payments, charge master, and reconciliation workflow. Notion is retired as a live RCM source.
- CRISP CEND / ENS — Maryland HIE hospital admit/discharge/transfer feed powering the Hospital & TCM worklist and the TCM billing clock. Roster-in (panel CSV, ≤90 days), notifications-out (HL7 ADT).
CRISP CEND - Care Management + payer/CMS files — active chronic registry and patient care gaps. CRISP is not the care-gap source.
Practice Management & Benchmarks
- MGMA — Practice Analytics & Benchmarks. Admin training and benchmark data for independent practices; basis for the KPI targets and A/R / denial benchmarks.
MGMA Analytics demo - MGMA — Financial Optimization for Physician Practices. Assessment & improvement framework informing the P&L and revenue-leakage views.
Read the article - MGMA Analytics benchmark docs (2024 practice analytics packets) — reference for productivity and revenue benchmarks. On file
Denials & Coding Integrity
- Adonis — The Rise of Systematic Downcoding. The basis for the Downcoding Watch on the Remittance page: payers algorithmically reducing E/M levels, and how to detect and appeal it.
Read the report - Medicare — data-driven performance payment framework. Reference for the Quality & MIPS section and the shift of fee-schedule dollars onto measured performance. On file (PDF)
Revenue Cycle Method
- “Revenue Cycle Management — Don’t Get Lost in the Financial Maze.” End-to-end RCM reference behind the stage model (front-end → submission → follow-up → appeal → write-off). On file (book)
- “Roadmaps.” Process-flow reference for the Payment Recovery Timeline phases. On file (book)
Monthly Summary
The familiar billing-summary format plus the month-end checklist, computed from live claims and payments. Data-driven flags surface what still needs work.
Month-End Close Checklist
0 / 0Collection by Payer
| Payer | Claims | Billed | Collected | Rate |
|---|
Denials by Payer
| Payer | Denied Claims | Denied $ |
|---|
Provider Breakdown
| Provider | Claims | Billed | Collected | Rate |
|---|
Status Breakdown
| Status | Claims | Billed | Collected |
|---|