Command: weekly-denials-worklist

Consolidate denied and aging claims into a prioritized worklist, assigning a next action to each.

Inputs

• Denial age threshold — days past denial date to flag for escalation; default 30
• Claim filter criteria — claim type (medical, dental, etc.), payer, date range; defaults to past 90 days
• Assignee routing rule — role or team to assign claims (appeal specialist, compliance, revenue cycle); default: revenue cycle team
• Organization ID — opaque org identifier; no patient names or DOB in payload
• Payer contact info source — lookup table for payer phone/fax/portal; auto-populate or manual override

Steps

1. Query claims system for denied claims and claims aging beyond the specified threshold.
2. Deduplicate by claim ID; group by denial reason category (authorization denial, coding error, medical necessity, duplicate submission, etc.).
3. For each claim, create a board task with claim ID, denial reason code, appeal deadline, and a placeholder for next action.
4. Assign tasks per routing rule; include payer name, contact requirements, and any required documentation flags.
5. Tag tasks by urgency: critical (appeal deadline within 7 days), high (10–20 days remaining), standard (21+ days).
6. Post task count summary to the assigned team, sorted by urgency tier.

Constraints

• No patient or member PHI (names, DOB, medical conditions) in task titles or descriptions; use claim IDs and record identifiers only.
• Org must confirm BAA (Business Associate Agreement) coverage before this command runs; assume attestation is verified upstream.
• Do not prescribe clinical review steps or clinical decision logic; restrict to administrative actions only (appeal filing, documentation gathering, payer contact).

Done when: all denied and 30-day-aged claims have an open board task with denial reason and assigned next action, stratified by urgency.