Documentation gaps — coding integrity
The coding integrity model is the core of this screen, and it reads in both directions: charts whose own results support a diagnosis that is absent from the problem list (a care and revenue gap), and money billed with no clinical note on file to support it (a compliance gap). A tool that only finds revenue is upcoding with better branding; one that reads both ways is documentation integrity. The model drafts queries for humans — it never changes a code or a note.
15
supported diagnoses missing from problem lists
8
billed claims with no supporting note in ±45 days
Under-coded — the chart supports a diagnosis nothing carries
| Patient | Suggested diagnosis | Evidence, from the record | |
|---|---|---|---|
| Ngan Murphy
MRN-209863 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 6 results (worst 7.900%, latest 2026-08-22) — no "diabetes" on the problem list | |
| Noor Jones
MRN-213939 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 5 results (worst 9.100%, latest 2026-03-07) — no "diabetes" on the problem list | |
| Ingrid Bianchi
MRN-225856 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 5 results (worst 9.400%, latest 2025-10-10) — no "diabetes" on the problem list | |
| Richard Santos
MRN-204957 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 5 results (worst 8.400%, latest 2026-11-10) — no "diabetes" on the problem list | |
| Viktor Gomez
MRN-227817 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 5 results (worst 9.100%, latest 2026-10-08) — no "diabetes" on the problem list | |
| Mathew Kenneth Stamm
MRN-105520 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 7.268mL/min, latest 2017-02-28) — no "kidney disease" on the problem list | |
| Elena Pilar Gomez
MRN-101642 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 5.927mL/min, latest 2022-10-02) — no "kidney disease" on the problem list | |
| Alvaro Isidro MacGyver
MRN-100452 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 5.991mL/min, latest 2022-09-22) — no "kidney disease" on the problem list | |
| Sebastian Antonio Gomez
MRN-100312 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 5.163mL/min, latest 2021-04-22) — no "kidney disease" on the problem list | |
| Lemuel Kuvalis
MRN-104722 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 10.444mL/min, latest 2021-01-31) — no "kidney disease" on the problem list | |
| Vera Lee
MRN-219357 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 5 results (worst 155.900mmHg, latest 2026-08-07) — no "hypertension" on the problem list | |
| Aarav Weber
MRN-228048 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 5 results (worst 168.100mmHg, latest 2026-10-22) — no "hypertension" on the problem list | |
| Salma Marisol Lewis
MRN-206130 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 4 results (worst 168.400mmHg, latest 2026-10-17) — no "hypertension" on the problem list | |
| Zuri Riya Lewandowski
MRN-231150 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 4 results (worst 164.000mmHg, latest 2026-05-09) — no "hypertension" on the problem list | |
| An Le
MRN-227580 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 4 results (worst 168.100mmHg, latest 2025-05-16) — no "hypertension" on the problem list |
Under-documented — billed without a note to support it
| Claim | Patient | Payer | Service date | Billed | Finding |
|---|---|---|---|---|---|
| CLM-2026501006 | Ivan Anatoly Gomez | Aetna | 2024-07-04 | $56,086.04 | No clinical note within 45 days of the billed service. |
| CLM-2026375005 | Ericka Rowe | Aetna | 2026-04-01 | $55,124.98 | No clinical note within 45 days of the billed service. |
| CLM-2026960007 | Rosina Jalisa Hamill | Medicaid | 2026-01-11 | $50,478.73 | No clinical note within 45 days of the billed service. |
| CLM-2026405007 | Galina Vera Gomez | Humana | 2026-02-19 | $49,711.40 | No clinical note within 45 days of the billed service. |
| CLM-20261101004 | Yelena Vera Gomez | Blue Cross Blue Shield | 2026-06-13 | $45,305.17 | No clinical note within 45 days of the billed service. |
| CLM-2026078007 | Audrea Prudence Doyle | Medicaid | 2025-03-13 | $42,069.87 | No clinical note within 45 days of the billed service. |
| CLM-2026088007 | Beatris Troy Olson | Aetna | 2026-03-01 | $39,878.51 | No clinical note within 45 days of the billed service. |
| CLM-2026146005 | Bulah Peg Cartwright | Humana | 2026-04-07 | $38,955.48 | No clinical note within 45 days of the billed service. |
The coder codes; the clinician documents. A drafted
query lands in the signature queue with its evidence attached; the clinician
confirms or rejects the diagnosis, and only that human decision changes
anything. Accepted queries become documentation — never silent code
changes.
✦ AI Chart audit — the codes vs the documentation
Pick a claim and the audit assistant reads the patient's actual notes against the billed lines: codes the documentation supports (with the sentence quoted), codes billed without support, and conditions documented but never billed. The memo files to the signature queue. One analysis per claim, cached; every inference audited.