Ohtariv0.0.4
OS

Ortho1 Surgical Group

Orthopedic Surgery

  • Teams
    • CL

    Clinical

      Tickets
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    BL

    Billing

    FO

    Front Office

KD

Kristopher Downing

Owner-Partner
Unpublished changes
Chat
Manual
O

Ohtari

Workflow builder

K
Every month I want Ohtari to pull all paid claims, compare the allowed amount to what our contract says we should be paid, identify any procedures where we're consistently getting paid below contracted rate, and generate a list of payers and CPT codes to take action on — either resubmit, appeal, or flag for contract renegotiation.
+ Add Availity ERA cross-check
⚙ Adjust variance threshold
+ Add quarterly trend comparison
+ Add contract expiry alerts
Trigger

1st of each month — prior month claim pull

Request made by

Approval required
default

Approved by: Senior biller · Practice manager (renegotiation flags)

Human sign-off required before any patient, chart, claim, or financial action runs.

Athena · Read

Pull all paid claims from prior month

claim.id, CPT, payer, billed_amount, allowed_amount, paid_amount, adjustment_codes

Rate compare

Compare allowed amounts vs. contracted rates

Payer contract fee schedule (Billing skill — Payer Contract Rates)

Conditional

Classify each variance: resubmit, appeal, or renegotiate?

Claim-level underpayment with clear contract support — auto-draft resubmission

Report

Generate biller action list + recovery report

Sorted by recoverable dollars · grouped by action type · include claim IDs and evidence

Athena · Write

Log audit results and open action items

Audit date · claims reviewed · variances found · actions opened · estimated recovery