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KadmoonINC.
Healthcare

Claims denial and length-of-stay BI

Clinical operations and billing on one model, tracking claim denials by payer and reason and length of stay by unit and specialty.

Power BIMicrosoft FabricDAXMicrosoft Purview
Occupancy rate
84.6%
operational beds
Average length of stay
4.2 days
all specialties
Claim denial
6.8%
on billing submitted
Revenue per bed-day
$2,140
net of claim denial

Illustrative figures · fictitious client · under NDA

The challenge

A hospital network lost revenue to claim denials it could not explain and could not see length of stay in time to manage capacity, with clinical and billing data apart.

What we built

We brought clinical operations and billing onto a governed model and built Power BI dashboards for claim denials by payer and reason and length of stay by unit and specialty, built with HIPAA in mind.

  • A governed model joining clinical operations and billing.
  • Claim denials by payer and reason.
  • Length of stay by unit and specialty.

Outcomes

  • Denials traced to payer and reason so they can be worked.
  • Length of stay visible in time to manage capacity.
  • Clinical and billing on the same numbers.

The dashboard we delivered

Clinical Operations and Billing · Hospital Networkgold_assistencial · HIS + ERPRefreshed 07/08 05:35Illustrative data
Report pages
Filters
Period
Jul/2026
Payer
All
Acuity
Elective and urgent
Hierarchy
Unit
Specialty
Encounter
Unit · consolidated
Occupancy rate+2.4 p.p.
84.6%
operational beds
Average length of stay-0.6 day
4.2 days
all specialties
Claim denial-2.3 p.p.
6.8%
on billing submitted
Revenue per bed-day+$180
$2,140
net of claim denial
Admissions this month
3,482
Readmission within 30 days
7.1%
Bed turnover
6.2
Billed accounts
18.4K

Claim denial over billing

Monthly percentage, against the 5% target

Claim denialTarget
9.7%7.9%6.3%4.6%
AugSepOctNovDecJanFebMarAprMayJunJul

Billing by unit

Click to open by specialty

The South Side unit concentrates 34% of revenue and 41% of claim denials: account audit under review.

Encounters in the slice

One row per hospital account submitted

8 of 160 rows
Encounter
Specialty
Payer
Billed
Claim denial
Length of stay
Account status
ATD-986841South Side Hospital · Ambulatory
Cardiology
SulAmérica
$38K
5.5%
-
Partial denial
ATD-976723South Side Hospital · ICU
Cardiology
Out-of-pocket
$32K
19.2%
2.6 d
In appeal
ATD-956018Central Hospital · ICU
Oncology
Amil
$26K
11.0%
4.4 d
In appeal
ATD-998895Central Hospital · Urgent
Oncology
Amil
$16K
11.7%
6.3 d
In appeal
ATD-962073North Hospital · Urgent
Internal medicine
Saúde Aliança
$21K
11.7%
14.1 d
In appeal
ATD-943914North Hospital · Ambulatory
Internal medicine
Saúde Aliança
$38K
4.5%
-
Partial denial
ATD-962656East Maternity · Urgent
Obstetrics
Unimed regional
$18K
8.9%
13.0 d
In appeal
ATD-969927East Maternity · Urgent
Obstetrics
Unimed regional
$13K
10.8%
6.5 d
In appeal

Illustrative dashboard with the structure delivered on the project. Client names and figures are fictitious and under NDA.

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