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 2026-04-24) — no "diabetes" on the problem list | |
| Yelena Gomez
MRN-216813 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 5 results (worst 9.500%, latest 2026-02-23) — no "diabetes" on the problem list | |
| Vera Lee
MRN-219357 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 5 results (worst 8.900%, latest 2025-11-08) — no "diabetes" on the problem list | |
| Konstantin Gomez
MRN-206319 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 5 results (worst 8.500%, latest 2026-07-31) — no "diabetes" on the problem list | |
| Gabriela Josefina Gomez
MRN-213600 |
Type 2 diabetes mellitus | Hemoglobin A1c >= 6.5% on 5 results (worst 9.000%, latest 2026-07-08) — no "diabetes" on the problem list | |
| Julius Spinka
MRN-104141 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 8.135mL/min, latest 2018-11-03) — no "kidney disease" on the problem list | |
| Belinda Rosella Schulist
MRN-100851 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 6.458mL/min, latest 2020-08-07) — no "kidney disease" on the problem list | |
| Santa Aleida Crona
MRN-107172 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 5.063mL/min, latest 2020-09-26) — no "kidney disease" on the problem list | |
| Azucena Hellen Kuphal
MRN-100774 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 8.364mL/min, latest 2020-08-24) — no "kidney disease" on the problem list | |
| Anton Elmer Boyer
MRN-100669 |
Chronic kidney disease | eGFR < 60mL/min on 4 results (worst 5.073mL/min, latest 2021-07-29) — no "kidney disease" on the problem list | |
| Aarav Weber
MRN-228048 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 5 results (worst 168.100mmHg, latest 2026-06-24) — no "hypertension" on the problem list | |
| Vera Lee
MRN-219357 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 5 results (worst 155.900mmHg, latest 2026-04-09) — no "hypertension" on the problem list | |
| Isabela Paloma Gomez
MRN-216420 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 4 results (worst 168.000mmHg, latest 2024-08-27) — no "hypertension" on the problem list | |
| Yusuf Duc Patel
MRN-210942 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 4 results (worst 171.000mmHg, latest 2026-06-11) — no "hypertension" on the problem list | |
| Tariq Kaminski
MRN-216628 |
Essential hypertension | Systolic blood pressure >= 140mmHg on 4 results (worst 156.700mmHg, latest 2025-11-21) — 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 | 2024-03-06 | $56,086.04 | No clinical note within 45 days of the billed service. |
| CLM-2026375005 | Ericka Rowe | Aetna | 2025-12-02 | $55,124.98 | No clinical note within 45 days of the billed service. |
| CLM-2026483004 | Irene Denyse Predovic | Medicare | 2026-01-06 | $53,715.17 | No clinical note within 45 days of the billed service. |
| CLM-2026960007 | Rosina Jalisa Hamill | Medicaid | 2025-09-13 | $50,478.73 | No clinical note within 45 days of the billed service. |
| CLM-2026405007 | Galina Vera Gomez | Humana | 2025-10-22 | $49,711.40 | No clinical note within 45 days of the billed service. |
| CLM-20261101004 | Yelena Vera Gomez | Blue Cross Blue Shield | 2026-02-13 | $45,305.17 | No clinical note within 45 days of the billed service. |
| CLM-2026078007 | Audrea Prudence Doyle | Medicaid | 2024-11-13 | $42,069.87 | No clinical note within 45 days of the billed service. |
| CLM-2026603005 | Roman Gomez | Medicaid | 2022-06-12 | $41,416.62 | 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.