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Text-semibold/2xs : 10px: Inter 10px weight-600 Text-medium/2xs : 10px: Inter 10px weight-500 Text-normal/2xs : 10px: Inter 10px weight-400 Text-bold/2xs : 10px: Inter 10px weight-700 Text-hairline/Text-thin/2xs : 10px: Inter 10px weight-100 Heading/5xl : 60px: Inter 60px weight-700 Text-bold/xs : 12px: Inter 12px weight-700 Text-hairline/Text-thin/3xl : 30px: Inter 30px weight-100 Text-hairline/Text-thin/md : 16px: Inter 16px weight-100 Text-bold/md : 16px: Inter 16px weight-700 Text-medium/lg : 18px: Inter 18px weight-500 Text-light/5xl : 48px: Inter 48px weight-300 Text-light/4xl : 36px: Inter 36px weight-300 Text-light/2xl : 24px: Inter 24px weight-300 Text-light/xs : 12px: Inter 12px weight-300 Text-medium/md : 16px: Inter 16px weight-500 ## Problem this solves SNF billing staff and clinicians operate in a fragmented revenue cycle where clinical documentation and billing workflows live in entirely separate systems — and the handoff between them is manual, error-prone, and slow. A nurse practitioner finishes a visit, documents in Carebrain (or PCC), and then a biller in a separate RCM tool reconstructs that encounter from scratch: pulling the code suggestions, verifying payer rules, generating the UB-04 or CMS-1500, and chasing denials through yet another portal. For a skilled nursing facility running 20–50 encounters per day across a blended payer mix of Medicare Part A, Medicare Advantage, and Medicaid, every gap in that handoff is a missed charge, a delayed payment, or a denial that takes 30–60 days to resolve. Carebrain already captures the clinical encounter and suggests ICD-10 and CPT codes with 98% accuracy — but today that intelligence stops at the edge of the note, and none of it flows automatically into a claim. The consequence for SNF operators is direct revenue leakage. PDPM reimbursement under Medicare Part A is driven by MDS-derived HIPPS codes — and inaccurate or incomplete coding from a disconnected workflow is the single largest driver of RAC audit exposure and underpayment in this setting. Medicare Advantage pressure, now cited by 56% of SNF operators as their top financial concern in 2026, compounds this: MA authorizations require documentation that meets payer-specific clinical criteria, and denials management for MA claims is manual and time-intensive when billing lives outside the clinical record. SNFs operating on 2–4% net margins cannot absorb the operational drag of a billing process that is structurally disconnected from the clinical reality Carebrain already captures. The timing argument is real but sequenced: Carebrain's code suggestion engine, PCC integration (with ADT events, demographics, and insurance data), and the PDPM Billing Suggestions work already in backlog (PR-28) create the data foundation for a billing workflow layer. The market is beginning to expect this — GEHRiMed ships built-in RCM, ChartPath tiers billing at $225–450/provider/month, and PointClickCare's new Advisor product signals that the EHR layer itself is moving into billing intelligence. Carebrain must decide whether to build this foundation now, before the window closes, or remain a documentation tool that hands off to a competitor's billing system for the foreseeable future. ## MVP scope (what to build) MVP is a Charge Capture and Claim Draft module for SNF physician/NP professional billing (CMS-1500), not facility billing (UB-04). This is the right starting point because: (1) Carebrain already captures the encounter, suggests CPT and ICD-10 codes, and knows the provider NPI — the data to generate a CMS-1500 draft is already present; (2) physician professional billing is structurally simpler than facility PDPM/UB-04 billing and does not require MDS HIPPS logic to launch; (3) it matches the primary Carebrain user (the physician or NP), not a separate billing department, reducing the sales and change management complexity of the first deployment. MVP delivers: (a) automatic charge capture triggered by note signature — no separate billing action required from the clinician; (b) a pre-populated CMS-1500 draft surfaced in a Billing queue within Carebrain, editable by a billing coordinator before submission; (c) clearinghouse submission via a partner integration (Availity or equivalent); (d) a simple claim status tracker showing submitted, accepted, denied, and paid states per claim; and (e) denial reason display with a one-click 'draft appeal' action that pre-populates appeal text from the clinical note. Target: prove value at 2 Carebrain accounts with active physician or NP users, targeting 90-day reduction in days-in-AR and biller time savings as the validation metrics. ## All user stories - every one must be reflected in the UI 1. As a SNF billing coordinator, I want charge capture to happen automatically from completed Carebrain encounter notes so that I am not re-entering encounter data into a separate billing system every day. 2. As a SNF billing coordinator, I want to review a pre-populated claim draft with ICD-10, CPT, and HIPPS codes pulled from the clinical note before it is submitted so that I can catch coding errors before they become denials. 3. As a SNF billing coordinator, I want to see all outstanding claims, their payer status, and denial reasons in a single queue so that I can prioritize follow-up without logging into multiple portals. 4. As a SNF billing coordinator, I want the system to flag when a Medicare Advantage claim requires supporting documentation before submission so that I can attach the required authorization or clinical record proactively rather than after denial. 5. As a Director of Nursing (DON) or facility administrator, I want a real-time dashboard showing submitted revenue, open AR by payer, and denial rate trends so that I can identify revenue leakage without waiting for a monthly billing report. 6. As a physician or NP completing an encounter in Carebrain, I want my signed note to automatically trigger charge capture so that I never have to take a separate billing action after documentation is complete. 7. As an MDS Coordinator, I want the billing system to alert me when a HIPPS code derived from a completed MDS assessment does not match the CPT/revenue codes on the corresponding Part A claim so that I can investigate and correct before the claim ages. 8. As a SNF operator managing a multi-facility portfolio, I want consolidated billing performance reporting across all sites so that I can identify which facilities have the highest denial rates and intervene with targeted workflow corrections. 9. As a SNF billing coordinator, I want AI-drafted denial appeal text pre-populated from the clinical note and payer denial reason so that I can submit appeals faster without writing responses from scratch. 10. As a facility administrator, I want the billing system to flag encounters where PDPM case-mix optimization opportunities were missed — for example, a high-acuity comorbidity present in the chart but not reflected in the MDS coding — so that rebilling or addendum workflows can be initiated before the claim window closes. ## Success metrics - design the UI to make these measurable - Charge capture rate: ≥95% of completed, signed Carebrain encounters auto-generate a claim draft within 24 hours of note signature, with no manual re-entry required - First-pass claim acceptance rate: ≥90% of submitted claims accepted by clearinghouse on first pass (baseline: industry SNF average is approximately 80–85%) - Days in AR reduction: Participating SNF facilities reduce average days in AR from initial baseline by ≥15% within 90 days of go-live - Denial rate: Medicare Part A and Medicare Advantage denial rate ≤8% of submitted claims within 6 months of go-live (industry average is approximately 10–15%) - Biller time savings: Billing coordinators report ≥2 hours per day saved on charge entry and claim prep, validated via user survey at 60 days post-launch - PDPM coding accuracy lift: ≥10% increase in average HIPPS code accuracy vs. pre-Carebrain baseline at pilot facilities, measured by RAC audit flag rate or internal coding review - Revenue recovered per facility per month: ≥$8,000 in incremental reimbursement per facility per month attributable to correct PDPM coding and denial recovery, validated against prior-period billing data - Daily active billing users: ≥80% of enrolled billing coordinators log into the billing module at least 4 days per week within 60 days of go-live ## UI spec Build a web dashboard for Carebrain, an AI platform for Skilled Nursing Facilities. Brand color: deep purple #9333EA. Screen: Billing Queue Dashboard. Layout: left sidebar nav (deep purple, white icons) with items Home, Patients, Notes, Billing (active, highlighted), Settings. Main content area header: 'Billing Queue' with a date filter and a blue-outlined 'Submit Selected' button. Below the header: five tab pills — Draft (23), Submitted (41), Accepted (18), Denied (7), Paid (112) — with Draft tab active. Table rows show: patient name, date of service, CPT code, ICD-10 code, payer name (Medicare/MA/Medicaid), claim amount, and an action button ('Review'). One row is highlighted in amber to indicate a denial flag. Right panel (slide-in): claim detail with inline clinical note excerpt, editable code fields, and a purple 'Submit Claim' CTA. Clean, clinical, minimal. ## Design reference Screen: 'Billing Queue — Draft Claims'. Components: (1) Top navigation bar in deep purple (#9333EA) with Carebrain wordmark and user avatar. (2) Secondary tab bar: Draft | Submitted | Accepted | Denied | Paid with badge counts. (3) Claims data table — columns: Patient, Date of Service, Provider, CPT, ICD-10, Payer, Amount, Status chip, Action. Row hover state: light purple (#F3E8FF) highlight. (4) Right-panel drawer: Claim Detail — shows pre-populated CMS-1500 fields, inline source note excerpt in a gray card, editable ICD/CPT fields, and a full-width purple 'Submit Claim' button. Denial rows show amber status chip and 'Draft Appeal' action. Typography: Inter. Spacing: 8px grid. Style: clinical, minimal, high-contrast. ## Platform components to reuse - PCC Marketplace Patient & Payer Data Feed (data-source): Pulls patient demographics, insurance/payer IDs, admission dates, and ADT events from PointClickCare Marketplace to pre-populate CMS-1500 claim fields; already partially active via Carebrain's existing PCC Marketplace listing per carebrain-site and pcc-knowledge-base. - Signed Encounter Note Store (data-source): The completed and signed SOAP note from the AI scribe workflow serves as the authoritative source record for charge capture; note signature event is the trigger for downstream claim draft generation per carebrain-site workflow. - ICD-10 / CPT Code Suggestion Engine (model): Carebrain's existing 98% accuracy code suggestion model (per carebrain-site) supplies the ICD-10 and CPT codes that populate the claim draft; MVP extends its output schema to include place-of-service codes and modifier flags required for CMS-1500 professional claims in SNF settings. ## New components to build - Charge Capture Trigger Pipeline (pipeline): Listens for note-signature events from the encounter store and automatically initiates a charge capture record, pulling codes from the coding engine and patient/payer data from the PCC feed into a structured claim payload; eliminates the manual handoff between clinician documentation and billing staff described in the problem frame. - CMS-1500 Claim Draft Builder (model): Maps the charge capture payload to the required CMS-1500 field structure (Box 21 diagnoses, Box 24 service lines, Box 33 billing provider NPI, etc.) and produces a review-ready claim draft; SNF-specific logic encodes place-of-service code 31 (SNF) and handles attending vs. rendering provider distinctions common in rounding physician workflows per chartpath and gehrimed context. - Clearinghouse Submission Integration (integration): Partner-built integration with a clearinghouse (Availity or Waystar preferred given SNF payer coverage) to transmit validated CMS-1500 claims and receive 277 status responses and CARC/RARC denial codes back into the Carebrain claim queue; structured as a third-party API partnership rather than an internal clearinghouse build per MVP scope definition. - Billing Coordinator Claim Review Workflow (workflow): Surfaces pre-populated claim drafts to billing coordinators in a prioritized queue inside Carebrain; supports field-level editing, hold/approve/submit actions, and inline display of the source clinical note for reference; modeled on the review-and-approve interaction pattern validated by GEHRiMed and Commure's autonomous coding workflows. - Denial Management and Appeal Workflow (workflow): When a 277 denial response is received from the clearinghouse, surfaces the denial reason code alongside the original clinical note and pre-populates an appeal letter draft; billing coordinator reviews and submits; directly addresses the MA authorization denial pain cited by 56% of SNF operators in the skilled-nursing-news source. - Billing Queue Dashboard (ui-component): New Carebrain UI surface showing all claims segmented by status (Draft, Submitted, Accepted, Denied, Paid) with AR aging, denial rate by payer, and one-click drill-down into individual claim detail; scoped to single-facility view for MVP, with multi-facility rollup deferred to next-level scope. - Billing Module API (api): Internal REST API exposing claim status, AR metrics, and denial data to future integrations (e.g., operator-level analytics dashboard, third-party RCM services partners); defined in MVP but not externally published until next-level scope to avoid premature commitment to an API contract. ## Technical requirements - Next.js App Router page (default export), TypeScript, Tailwind CSS - Use shadcn/ui: Button, Card, Badge, Input, Select, Table, Skeleton, Dialog as needed - Full interactivity: real state, handlers, forms - no placeholder TODOs - Loading state (Skeleton), empty state (with CTA), error state - Hover/focus states on all interactive elements - Mobile-first (sm: breakpoints). Min touch target 44px. - High contrast text (≥4.5:1). SNF clinical context - clarity over decoration. ## Full spec (reference) # PRD: Internal SNF Billing System **Status:** DRAFT | **Owner:** Carebrain PM | **Last updated:** 2026-06-11 --- ## TLDR Build a Charge Capture and Claim Draft module inside Carebrain that automatically converts signed encounter notes into review-ready CMS-1500 claim drafts, submits them via a clearinghouse partner, and surfaces a denial management queue — eliminating the manual handoff between Carebrain's clinical documentation and the billing coordinator's separate RCM tool. MVP targets physician and NP professional billing (CMS-1500) at 2 pilot SNF accounts. Next-level expands to full facility PDPM/UB-04 billing. --- ## Why Now Three forces are converging: 1. **Market pressure is acute.** 56% of SNF operators cite Medicare Advantage as their top financial concern in 2026. MA denials are manual, time-intensive, and growing. SNFs operating on 2–4% net margins cannot absorb a billing process structurally disconnected from the clinical record. 2. **Carebrain's data foundation is ready.** We already capture the encounter, suggest ICD-10 and CPT codes at 98% accuracy, and pull patient demographics and ADT events from the PointClickCare Marketplace. The CMS-1500 data is already in Carebrain — it just stops at the edge of the note today. 3. **The window is closing.** GEHRiMed ships built-in RCM. ChartPath tiers billing from $225–$450/provider/month. PointClickCare's newly announced Advisor product signals the EHR layer itself is moving into billing intelligence. Every quarter Carebrain delays, a competitor embeds deeper into the billing workflow at our accounts. PR-28 (PDPM Billing Suggestions) is already in backlog and will produce the HIPPS code logic needed for next-level UB-04 billing — sequencing this work now avoids duplicate domain modeling effort. --- ## Problem SNF billing staff and clinicians operate in a fragmented revenue cycle where clinical documentation and billing workflows live in entirely separate systems — and the handoff between them is manual, error-prone, and slow. A nurse practitioner finishes a visit, documents in Carebrain, and a biller in a separate RCM tool reconstructs that encounter from scratch: pulling code suggestions, verifying payer rules, generating the UB-04 or CMS-1500, and chasing denials through yet another portal. For a facility running 20–50 encounters per day across Medicare Part A, Medicare Advantage, and Medicaid, every gap in that handoff is a missed charge, a delayed payment, or a denial that takes 30–60 days to resolve. PDPM reimbursement under Medicare Part A is driven by MDS-derived HIPPS codes. Inaccurate or incomplete coding from a disconnected workflow is the single largest driver of RAC audit exposure and underpayment in this setting. Carebrain already captures the clinical encounter and suggests codes — but today that intelligence stops at the edge of the note, and none of it flows automatically into a claim. --- ## Users | User | Role | Primary Pain | |---|---|---| | **SNF Billing Coordinator** | Reviews, edits, and submits claims; manages denials and appeals | Re-enters encounter data daily into a separate RCM system; tracks denial queues across multiple portals | | **Physician / NP (Rounding Provider)** | Documents visits in Carebrain; signs notes | Must take a separate billing action after note completion; uncertain whether codes will reach the biller correctly | | **Director of Nursing / Facility Administrator** | Oversees clinical and financial operations | No real-time visibility into submitted revenue, open AR, or denial trends without waiting for a monthly billing report | | **MDS Coordinator** | Manages federally mandated MDS assessments | HIPPS codes derived from MDS assessments must align with claim codes — mismatches create RAC audit risk with no current alert mechanism | | **Multi-Facility Operator (Portfolio Level)** | Manages billing performance across 5–50+ SNFs | No consolidated denial rate or AR aging view across sites; must rely on facility-level reports that arrive late | --- ## Example User Story: Maya (Billing Coordinator, 3-SNF Regional Group) Maya manages billing for three SNFs in a regional operator group. Each morning she logs into her external RCM tool and manually rebuilds the previous day's encounters from a spreadsheet export sent by the DON. She cross-references ICD-10 codes with what the providers documented, adds CPT codes from a fee schedule, and constructs CMS-1500 claims line by line. This takes 2–3 hours before she touches a single denial. Her Medicare Advantage denial rate runs at 14%. When a denial comes in, she has to retrieve the original note from PCC, read through it to find supporting language for the appeal, draft the letter from scratch, and resubmit — often 3–4 weeks after the initial denial, risking timely filing limits. **With Carebrain Billing MVP:** Maya opens Carebrain's Billing Queue each morning and sees 23 pre-populated claim drafts — each auto-generated the moment the provider signed their note the previous day. ICD-10 and CPT codes are already populated from Carebrain's coding engine. She reviews, makes two edits, and hits Submit All. Total time: 20 minutes. When a denial arrives from her MA payer, Carebrain surfaces the denial reason code, shows her the original clinical note inline, and pre-populates an appeal letter. She reviews, signs, and submits in 8 minutes rather than 45. --- ## MVP Scope MVP is **physician/NP professional billing (CMS-1500) only** — not facility PDPM/UB-04 billing. This is the right starting point: - Carebrain already has the encounter data, code suggestions, and provider NPI needed to generate a CMS-1500 without MDS HIPPS logic - It matches the primary Carebrain user (the physician or NP), reducing sales and change management complexity - CMS-1500 professional billing is structurally simpler than facility PDPM billing, enabling a faster validated learning cycle **MVP Deliverables:** 1. **Auto Charge Capture:** Note signature triggers automatic charge capture record — no separate billing action required from the clinician 2. **CMS-1500 Claim Draft:** Pre-populated draft surfaced in Billing Queue with ICD-10, CPT, place-of-service (31 = SNF), rendering provider NPI, and patient/payer data from PCC Marketplace 3. **Billing Queue UI:** New Carebrain screen segmenting claims by Draft / Submitted / Accepted / Denied / Paid; single-facility view; inline clinical note reference panel 4. **Clearinghouse Submission:** 837P claim transmission via Availity or Waystar partner integration; 277 status responses returned to queue 5. **Denial Display + Appeal Draft:** Denial reason code surfaced alongside clinical note; one-click AI-drafted appeal letter pre-populated from note content and denial code; coordinator reviews and submits **Out of MVP Scope:** - UB-04 / PDPM facility billing (deferred to Next Level) - Medicaid state portal EDI connectivity - Multi-facility portfolio dashboard - HIPPS code generation from MDS data - Managed RCM services / percentage-of-collections tier **Pilot:** 2 current Carebrain accounts with active physician/NP users. 90-day validation metrics: AR days reduction ≥15%, biller time savings ≥2 hours/day. --- ## Next Level Scope After MVP validation at 2 pilot accounts: 1. **UB-04 / PDPM Facility Billing:** HIPPS code generation from MDS data via PCC integration; consolidated billing logic encoding SNF Part A rules; revenue code mapping per PDPM case-mix component 2. **PDPM Case-Mix Optimization Alerts:** Flag when chart comorbidities or GG functional scores suggest a higher-acuity HIPPS code than was coded; one-click addendum workflow before claim window closes 3. **MA Prior Authorization Tracking:** Flag encounters requiring MA auth before submission; attach auth documentation directly to claim draft 4. **Multi-Facility Operator Dashboard:** Portfolio-level denial rate, AR aging, and revenue per facility with drill-down to individual claims 5. **Managed RCM Tier:** 4% of collections recovered via Carebrain-submitted claims; Carebrain or billing services partner handles denial appeals on operator's behalf; aligns Carebrain revenue to SNF operator collections performance --- ## Framework Nodes | Node | Type | Status | Notes | |---|---|---|---| | PCC Marketplace Patient & Payer Data Feed | data-source | reuses | Extend scope to include insurance payer ID, group/member number, attending NPI | | Signed Encounter Note Store | data-source | reuses | Note-signature event is the charge capture trigger | | ICD-10 / CPT Code Suggestion Engine | model | reuses | Extend output schema to include POS codes and modifier flags for CMS-1500 | | Charge Capture Trigger Pipeline | pipeline | new | Event-driven; listens for note-signature; initiates charge capture record | | CMS-1500 Claim Draft Builder | model | new | SNF-specific claim construction logic; POS 31; attending vs. rendering provider | | Clearinghouse Submission Integration | integration | new | 837P out / 277 + 835 in via Availity or Waystar | | Billing Coordinator Claim Review Workflow | workflow | new | Queue UI with review, edit, hold, approve, submit actions | | Denial Management and Appeal Workflow | workflow | new | 277 parsing + clinical note retrieval + AI appeal draft | | Billing Queue Dashboard | ui-component | new | Claim status segments, AR aging, denial rate by payer | | Billing Module API | api | new | Internal REST API; published externally at next-level scope | --- ## Success Metrics | Metric | Target | |---|---| | Charge capture rate | ≥95% of signed encounters auto-generate a claim draft within 24 hours, no manual re-entry | | First-pass acceptance rate | ≥90% of submitted claims accepted by clearinghouse on first pass (vs. ~80–85% industry average) | | Days in AR reduction | ≥15% reduction from baseline within 90 days of go-live | | Denial rate | ≤8% of submitted claims denied within 6 months (vs. 10–15% industry average) | | Biller time savings | ≥2 hours/day saved on charge entry and claim prep (user survey at 60 days) | | PDPM coding accuracy lift | ≥10% increase in HIPPS code accuracy vs. pre-Carebrain baseline (next-level) | | Revenue recovered | ≥$8,000 incremental reimbursement per facility per month (next-level) | | Daily active billing users | ≥80% of enrolled billing coordinators log in ≥4 days/week within 60 days | --- ## Business Goals - **Primary revenue:** $299/facility/month add-on for Charge Capture + Claim Draft module; targets 20 facilities in first 12 months post-launch = $71,760 ARR from billing module alone - **Upsell lever:** Managed RCM tier at 4% of collections creates a recurring, outcome-aligned revenue stream that scales with facility census - **Retention:** Billing module creates workflow lock-in that scribe alone cannot — once a billing coordinator's daily workflow runs inside Carebrain, churn risk drops materially - **Portfolio analytics product:** Billing denial and AR data aggregated across multi-facility operators becomes a premium analytics tier, consistent with Carebrain's SNF-depth strategy - **Competitive defense:** Prevents ChartPath or GEHRiMed from capturing the billing relationship at Carebrain's existing accounts before Carebrain owns it --- ## Assumptions | Assumption | Certainty (0–10) | Validation | |---|---|---| | Billing coordinators will migrate to Carebrain billing if it eliminates manual charge re-entry | 6 | 5–8 structured discovery interviews with billing coordinators at current accounts | | Existing coding engine output can be extended to CMS-1500 fields without a rebuild | 5 | Engineering spike: map coding engine output to CMS-1500 field schema; identify gap | | PCC Marketplace provides sufficient insurance and NPI data for claim pre-population | 7 | API audit of PCC Marketplace fields available to Carebrain in week 1 | | SNF operators will pay $299/facility/month as an incremental add-on | 6 | Test pricing in 3–5 sales calls before launch commitment | | MA denial pain is sufficient to drive near-term adoption even before UB-04 billing is complete | 7 | Ask billing users: denial rate and hours/week on MA appeals | | Clearinghouse partnership (Availity/Waystar) is achievable without building clearinghouse internally | 8 | Initiate partnership discussions immediately; 6–10 week legal/contracting cycle | | Billing module does not materially increase FCA liability beyond current HIPAA/BAA posture | 4 | Engage healthcare compliance counsel before any pilot launch commitment | | Single MVP billing workflow serves both independent SNFs and multi-facility operators | 5 | Map billing org structures at 3 independent + 3 multi-facility accounts before build | --- ## Open Questions 1. Does Carebrain's PCC Marketplace integration currently expose insurance payer ID, group/member number, and attending provider NPI — or does expanding scope require a new marketplace API request? 2. Which clearinghouse has the strongest SNF payer network coverage: Availity, Waystar, or Change Healthcare? What is the per-transaction cost and integration timeline? 3. Do billing coordinators at target accounts control their RCM tool purchasing decision, or does a centralized corporate billing department own that relationship — and if the latter, is the Carebrain billing module a facility-level or enterprise sale? 4. What is Carebrain's legal exposure under the False Claims Act when an AI system generates claim-ready output submitted under an operator's NPI? What contractual language is required to allocate liability before pilot launch? 5. Should the MVP billing module expose a Billing Coordinator user role as a distinct Carebrain login with scoped permissions, or should billing access be granted to existing Carebrain users — and what are the HIPAA minimum-necessary implications of each approach? 6. Is PR-28 (PDPM Billing Suggestions) being scoped in parallel with this initiative? If so, how do we prevent duplicate domain modeling of HIPPS code logic between the two workstreams? Deliver a production-grade initial version that engineers can build on directly. Not a wireframe.40:o9f7,ac:T503,I'm starting to build the Billing Queue Dashboard for the SNF system using the design tokens provided—deep purple branding, Inter font, 8px grid system with a clinical minimal aesthetic. I'm planning the main layout structure with a left sidebar navigation showing Home, Patients, Notes, Billing (active state), and Settings, plus a header containing the "Billing Queue" title, date filter controls, and a blue-outlined "Submit Selected" button. The core content area will feature five status tabs (Draft with 23 items, Submitted with 41, Accepted with 18, Denied with 7, and Paid with 112), followed by a comprehensive table displaying patient name, date of service, provider, CPT code, ICD-10 code, payer, amount, status chip, and a Review action button. I'll highlight denial rows in amber with a "Draft Appeal" option, and include a right-side drawer panel that shows claim details with clinical note excerpts, editable code fields, and a purple "Submit Claim" call-to-action button. I'm organizing this as a single cohesive dashboard page with multiple components rather than using TodoManager, splitting the build into separate component files for the sidebar, header, metrics dashboard, tabs, table, claim drawer, and appeal dialog to keep things modular and maintainable.ad:T4da,I'm establishing the design system with deep purple as the primary brand color and Inter as the typeface, using an 8px grid for a clean, minimal aesthetic. I'll set up the theme with a sidebar featuring a deep purple background and white icons alongside the main content area, then build out metric dashboard cards at the top to display key DON metrics like submitted revenue. Now I'm planning the full interface structure: a billing queue header with date filtering and bulk submit capabilities, tab pills showing claim counts, a data table with checkboxes and denial highlighting, a claim detail drawer that slides out with note excerpts and editable code fields, plus a draft appeal dialog for denied claims and alerts for MA documentation flags and HIPPS mismatches. I'll organize the codebase by creating a data layer with types and mock data, then building individual components for each section before tying everything together in the main page orchestrator. Setting up the design tokens with a deep purple primary color and using oklch color space for consistency, then I'll define custom CSS variables for the brand colors and use arbitrary hex values where needed for exact color matching. 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--destructive: oklch(0.396 0.141 25.723); --destructive-foreground: oklch(0.637 0.237 25.331); --border: oklch(0.269 0 0); --input: oklch(0.269 0 0); --ring: oklch(0.439 0 0); --chart-1: oklch(0.488 0.243 264.376); --chart-2: oklch(0.696 0.17 162.48); --chart-3: oklch(0.769 0.188 70.08); --chart-4: oklch(0.627 0.265 303.9); --chart-5: oklch(0.645 0.246 16.439); --sidebar: oklch(0.205 0 0); --sidebar-foreground: oklch(0.985 0 0); --sidebar-primary: oklch(0.488 0.243 264.376); --sidebar-primary-foreground: oklch(0.985 0 0); --sidebar-accent: oklch(0.269 0 0); --sidebar-accent-foreground: oklch(0.985 0 0); --sidebar-border: oklch(0.269 0 0); --sidebar-ring: oklch(0.439 0 0); } @theme inline { --font-sans: 'Inter', 'Inter Fallback', ui-sans-serif, system-ui, sans-serif; --font-mono: 'Geist Mono', 'Geist Mono Fallback'; --color-background: var(--background); --color-foreground: var(--foreground); --color-card: var(--card); --color-card-foreground: var(--card-foreground); --color-popover: var(--popover); --color-popover-foreground: var(--popover-foreground); --color-primary: var(--primary); --color-primary-foreground: var(--primary-foreground); --color-secondary: var(--secondary); --color-secondary-foreground: var(--secondary-foreground); --color-muted: var(--muted); --color-muted-foreground: var(--muted-foreground); --color-accent: var(--accent); --color-accent-foreground: var(--accent-foreground); --color-destructive: var(--destructive); --color-destructive-foreground: var(--destructive-foreground); --color-border: var(--border); --color-input: var(--input); --color-ring: var(--ring); --color-chart-1: var(--chart-1); --color-chart-2: var(--chart-2); --color-chart-3: var(--chart-3); --color-chart-4: var(--chart-4); --color-chart-5: var(--chart-5); --radius-sm: calc(var(--radius) - 4px); --radius-md: calc(var(--radius) - 2px); --radius-lg: var(--radius); --radius-xl: calc(var(--radius) + 4px); --color-sidebar: var(--sidebar); --color-sidebar-foreground: var(--sidebar-foreground); --color-sidebar-primary: var(--sidebar-primary); --color-sidebar-primary-foreground: var(--sidebar-primary-foreground); --color-sidebar-accent: var(--sidebar-accent); --color-sidebar-accent-foreground: var(--sidebar-accent-foreground); --color-sidebar-border: var(--sidebar-border); --color-sidebar-ring: var(--sidebar-ring); } @layer base { * { @apply border-border outline-ring/50; } body { @apply bg-background text-foreground; } } [V0_FILE]json:file="package.json" isMerged="true" { "name": "my-project", "version": "0.1.0", "private": true, "scripts": { "dev": "next dev", "build": "next build", "start": "next start", "lint": "eslint ." }, "dependencies": { "@hookform/resolvers": "^3.9.1", "@vercel/analytics": "1.6.1", "@radix-ui/react-accordion": "1.2.12", "@radix-ui/react-alert-dialog": "1.1.15", "@radix-ui/react-aspect-ratio": "1.1.8", "@radix-ui/react-avatar": "1.1.11", "@radix-ui/react-checkbox": "1.3.3", "@radix-ui/react-collapsible": "1.1.12", "@radix-ui/react-context-menu": "2.2.16", "@radix-ui/react-dialog": "1.1.15", "@radix-ui/react-dropdown-menu": "2.1.16", "@radix-ui/react-hover-card": "1.1.15", "@radix-ui/react-label": "2.1.8", "@radix-ui/react-menubar": "1.1.16", "@radix-ui/react-navigation-menu": "1.2.14", "@radix-ui/react-popover": "1.1.15", "@radix-ui/react-progress": "1.1.8", "@radix-ui/react-radio-group": "1.3.8", "@radix-ui/react-scroll-area": "1.2.10", "@radix-ui/react-select": "2.2.6", "@radix-ui/react-separator": "1.1.8", "@radix-ui/react-slider": "1.3.6", "@radix-ui/react-slot": "1.2.4", "@radix-ui/react-switch": "1.2.6", "@radix-ui/react-tabs": "1.1.13", "@radix-ui/react-toast": "1.2.15", "@radix-ui/react-toggle": "1.1.10", "@radix-ui/react-toggle-group": "1.1.11", "@radix-ui/react-tooltip": "1.2.8", "autoprefixer": "^10.4.20", "class-variance-authority": "^0.7.1", "clsx": "^2.1.1", "cmdk": "1.1.1", "date-fns": "4.1.0", "embla-carousel-react": "8.6.0", "input-otp": "1.4.2", "lucide-react": "^0.564.0", "next": "16.2.6", "next-themes": "^0.4.6", "react": "19.2.4", "react-day-picker": "9.13.2", "react-dom": "19.2.4", "react-hook-form": "^7.54.1", "react-resizable-panels": "^2.1.7", "recharts": "2.15.0", "sonner": "^1.7.1", "tailwind-merge": "^3.3.1", "vaul": "^1.1.2", "zod": "^3.24.1", "tailwindcss-animate": "1.0.7" }, "devDependencies": { "@tailwindcss/postcss": "^4.2.0", "@types/node": "^24", "@types/react": "19.2.14", "@types/react-dom": "19.2.3", "postcss": "^8.5", "tailwindcss": "^4.2.0", "tw-animate-css": "1.3.3", "typescript": "5.7.3" } } [V0_FILE]typescriptreact:file="app/layout.tsx" isMerged="true" import type { Metadata } from 'next' import { Inter, Geist_Mono } from 'next/font/google' import { Analytics } from '@vercel/analytics/next' import './globals.css' const _inter = Inter({ subsets: ["latin"], variable: "--font-inter" }); const _geistMono = Geist_Mono({ subsets: ["latin"] }); export const metadata: Metadata = { title: 'Billing Queue · Carebrain', description: 'Carebrain SNF billing — automatic charge capture, CMS-1500 claim drafts, and denial management for skilled nursing facilities.', generator: 'v0.app', icons: { icon: [ { url: '/icon-light-32x32.png', media: '(prefers-color-scheme: light)', }, { url: '/icon-dark-32x32.png', media: '(prefers-color-scheme: dark)', }, { url: '/icon.svg', type: 'image/svg+xml', }, ], apple: '/apple-icon.png', }, } export default function RootLayout({ children, }: Readonly<{ children: React.ReactNode }>) { return ( {children} {process.env.NODE_ENV === 'production' && } ) } [V0_FILE]typescript:file="lib/billing-data.ts" isMerged="true" // Domain model + mock data for the Carebrain SNF Billing Queue. // This mirrors the CMS-1500 professional-billing MVP scope: charge capture // from signed encounter notes -> claim draft -> clearinghouse -> denial mgmt. export type ClaimStatus = "draft" | "submitted" | "accepted" | "denied" | "paid" export type Payer = "Medicare Part A" | "Medicare Advantage" | "Medicaid" | "Medicare Part B" export type PayerClass = "medicare" | "ma" | "medicaid" export interface CptLine { code: string description: string modifiers: string[] units: number charge: number // cents pos: string // place of service, e.g. "31" (SNF) } export interface IcdCode { code: string description: string primary?: boolean } export interface Claim { id: string status: ClaimStatus patientName: string patientMrn: string dob: string roomBed: string dateOfService: string // ISO capturedAt: string // ISO — when charge capture fired after note signature provider: string providerNpi: string attendingProvider?: string payer: Payer payerClass: PayerClass memberId: string groupNumber?: string cpt: CptLine[] icd: IcdCode[] hipps?: string // HIPPS code when a matching Part A / MDS assessment exists amount: number // cents, total claim charge // note excerpt (source of truth) noteExcerpt: string noteSignedBy: string noteSignedAt: string // flags maDocRequired?: boolean // MA authorization / supporting doc needed pre-submission maDocAttached?: boolean hippsMismatch?: boolean // HIPPS from MDS != CPT/revenue codes on claim pdpmOpportunity?: string // missed case-mix optimization opportunity // lifecycle submittedAt?: string acceptedAt?: string paidAt?: string paidAmount?: number arDays?: number // days in AR (for submitted/accepted) // denial denial?: { date: string carc: string // Claim Adjustment Reason Code rarc?: string // Remittance Advice Remark Code reason: string timelyFilingDeadline: string } } export const PAYER_META: Record = { medicare: { label: "Medicare Part A / B", short: "Medicare", tone: "text-sky-700 bg-sky-50 border-sky-200" }, ma: { label: "Medicare Advantage", short: "MA", tone: "text-violet-700 bg-violet-50 border-violet-200" }, medicaid: { label: "Medicaid", short: "Medicaid", tone: "text-teal-700 bg-teal-50 border-teal-200" }, } export const STATUS_META: Record< ClaimStatus, { label: string; chip: string; dot: string } > = { draft: { label: "Draft", chip: "bg-muted text-foreground/70 border-border", dot: "bg-muted-foreground" }, submitted: { label: "Submitted", chip: "bg-sky-50 text-sky-700 border-sky-200", dot: "bg-sky-500" }, accepted: { label: "Accepted", chip: "bg-emerald-50 text-emerald-700 border-emerald-200", dot: "bg-emerald-500" }, denied: { label: "Denied", chip: "bg-amber-50 text-amber-800 border-amber-300", dot: "bg-amber-500" }, paid: { label: "Paid", chip: "bg-emerald-100 text-emerald-800 border-emerald-300", dot: "bg-emerald-600" }, } export function fmtUsd(cents: number): string { return (cents / 100).toLocaleString("en-US", { style: "currency", currency: "USD" }) } export function fmtDate(iso: string): string { return new Date(iso).toLocaleDateString("en-US", { month: "short", day: "numeric", year: "numeric" }) } export function fmtDateTime(iso: string): string { return new Date(iso).toLocaleString("en-US", { month: "short", day: "numeric", hour: "numeric", minute: "2-digit", }) } // ---- Mock claim set ------------------------------------------------------- export const CLAIMS: Claim[] = [ { id: "CLM-24817", status: "denied", patientName: "Eleanor Whitfield", patientMrn: "PV-100294", dob: "1938-04-12", roomBed: "214-A", dateOfService: "2026-06-03", capturedAt: "2026-06-03T18:42:00", provider: "Dr. Amara Rivera, NP", providerNpi: "1487256390", attendingProvider: "Dr. Louis Nassar, MD", payer: "Medicare Advantage", payerClass: "ma", memberId: "H8•••4471", groupNumber: "SNF-CO-22", cpt: [ { code: "99309", description: "Subsequent SNF visit, moderate", modifiers: ["25"], units: 1, charge: 14200, pos: "31" }, ], icd: [ { code: "I50.32", description: "Chronic diastolic (congestive) heart failure", primary: true }, { code: "E11.9", description: "Type 2 diabetes mellitus without complications" }, { code: "N18.4", description: "Chronic kidney disease, stage 4" }, ], amount: 14200, noteExcerpt: "Follow-up for CHF exacerbation. Pt with increased lower-extremity edema and 3 lb weight gain over 48h. Lungs with bibasilar crackles. Adjusted furosemide to 40mg BID. Discussed fluid restriction with nursing. Stage 4 CKD stable. Moderate complexity MDM given multiple chronic conditions with exacerbation.", noteSignedBy: "Dr. Amara Rivera, NP", noteSignedAt: "2026-06-03T18:40:00", maDocRequired: true, maDocAttached: false, submittedAt: "2026-06-04T09:15:00", arDays: 34, denial: { date: "2026-06-14", carc: "CARC 197", rarc: "RARC N657", reason: "Precertification/authorization absent. Supporting clinical documentation required for medical necessity of subsequent visit level.", timelyFilingDeadline: "2026-09-02", }, }, { id: "CLM-24902", status: "draft", patientName: "Marcus Delgado", patientMrn: "PV-100311", dob: "1945-09-30", roomBed: "108-B", dateOfService: "2026-06-10", capturedAt: "2026-06-10T17:05:00", provider: "Dr. Amara Rivera, NP", providerNpi: "1487256390", payer: "Medicare Part A", payerClass: "medicare", memberId: "1EG4•••MK72", cpt: [ { code: "99308", description: "Subsequent SNF visit, low", modifiers: [], units: 1, charge: 9600, pos: "31" }, ], icd: [ { code: "S72.011A", description: "Fracture of head of right femur, initial", primary: true }, { code: "Z96.641", description: "Presence of right artificial hip joint" }, ], amount: 9600, noteExcerpt: "POD 6 s/p right hip ORIF. Ambulating 40ft with front-wheel walker and contact-guard assist. Pain controlled on scheduled acetaminophen. Incision clean, dry, intact. Continue PT/OT BID. Low complexity interval visit.", noteSignedBy: "Dr. Amara Rivera, NP", noteSignedAt: "2026-06-10T17:02:00", hipps: "KBFL1", hippsMismatch: true, pdpmOpportunity: "Chart documents Stage 3 pressure injury (sacral) under Skin, but MDS Section M does not reflect it — this raises the Nursing case-mix component. Review before the 5-day assessment window closes.", }, { id: "CLM-24903", status: "draft", patientName: "Rosa Nguyen", patientMrn: "PV-100288", dob: "1951-01-18", roomBed: "222-A", dateOfService: "2026-06-10", capturedAt: "2026-06-10T16:20:00", provider: "Dr. Priya Shah, MD", providerNpi: "1902847561", payer: "Medicare Advantage", payerClass: "ma", memberId: "YPD•••9920", groupNumber: "SNF-CO-19", cpt: [ { code: "99310", description: "Subsequent SNF visit, high", modifiers: ["25"], units: 1, charge: 18900, pos: "31" }, ], icd: [ { code: "J44.1", description: "COPD with acute exacerbation", primary: true }, { code: "J96.01", description: "Acute respiratory failure with hypoxia" }, ], amount: 18900, noteExcerpt: "Acute COPD exacerbation with hypoxia, SpO2 88% on RA improved to 94% on 2L NC. Started prednisone taper and azithromycin. Frequent reassessment ordered. High complexity MDM: acute respiratory failure, drug management, and comorbidity burden.", noteSignedBy: "Dr. Priya Shah, MD", noteSignedAt: "2026-06-10T16:18:00", maDocRequired: true, maDocAttached: true, }, { id: "CLM-24904", status: "draft", patientName: "Harold Baumgartner", patientMrn: "PV-100256", dob: "1940-07-22", roomBed: "116-A", dateOfService: "2026-06-11", capturedAt: "2026-06-11T15:48:00", provider: "Dr. Amara Rivera, NP", providerNpi: "1487256390", payer: "Medicaid", payerClass: "medicaid", memberId: "CO•••33812", cpt: [ { code: "99307", description: "Subsequent SNF visit, straightforward", modifiers: [], units: 1, charge: 6400, pos: "31" }, ], icd: [ { code: "F03.90", description: "Unspecified dementia without behavioral disturbance", primary: true }, { code: "R26.81", description: "Unsteadiness on feet" }, ], amount: 6400, noteExcerpt: "Routine stable visit. Advanced dementia, at baseline. No acute distress. Eating 75% of meals with cueing. Fall precautions reinforced. No medication changes. Straightforward MDM.", noteSignedBy: "Dr. Amara Rivera, NP", noteSignedAt: "2026-06-11T15:45:00", }, { id: "CLM-24801", status: "submitted", patientName: "Gloria Sanderson", patientMrn: "PV-100201", dob: "1943-11-05", roomBed: "203-B", dateOfService: "2026-06-05", capturedAt: "2026-06-05T17:30:00", provider: "Dr. Priya Shah, MD", providerNpi: "1902847561", payer: "Medicare Part A", payerClass: "medicare", memberId: "3KW9•••TT41", cpt: [ { code: "99309", description: "Subsequent SNF visit, moderate", modifiers: [], units: 1, charge: 14200, pos: "31" }, ], icd: [ { code: "I63.9", description: "Cerebral infarction, unspecified", primary: true }, { code: "R47.01", description: "Aphasia" }, ], amount: 14200, noteExcerpt: "Post-stroke rehab. Improving expressive aphasia. Tolerating dysphagia diet. Continue SLP.", noteSignedBy: "Dr. Priya Shah, MD", noteSignedAt: "2026-06-05T17:28:00", submittedAt: "2026-06-05T18:00:00", arDays: 6, }, { id: "CLM-24788", status: "accepted", patientName: "Walter Kim", patientMrn: "PV-100177", dob: "1949-02-14", roomBed: "119-A", dateOfService: "2026-06-01", capturedAt: "2026-06-01T16:10:00", provider: "Dr. Amara Rivera, NP", providerNpi: "1487256390", payer: "Medicare Advantage", payerClass: "ma", memberId: "AET•••5540", groupNumber: "SNF-CO-22", cpt: [ { code: "99308", description: "Subsequent SNF visit, low", modifiers: [], units: 1, charge: 9600, pos: "31" }, ], icd: [{ code: "M17.11", description: "Unilateral primary osteoarthritis, right knee", primary: true }], amount: 9600, noteExcerpt: "s/p right TKA rehab, progressing with PT. ROM improving. Pain well controlled.", noteSignedBy: "Dr. Amara Rivera, NP", noteSignedAt: "2026-06-01T16:08:00", submittedAt: "2026-06-01T17:00:00", acceptedAt: "2026-06-02T08:30:00", arDays: 10, }, { id: "CLM-24705", status: "paid", patientName: "Doris Fairchild", patientMrn: "PV-100142", dob: "1936-06-08", roomBed: "210-A", dateOfService: "2026-05-20", capturedAt: "2026-05-20T17:55:00", provider: "Dr. Priya Shah, MD", providerNpi: "1902847561", payer: "Medicare Part A", payerClass: "medicare", memberId: "8TQ2•••LP03", cpt: [ { code: "99309", description: "Subsequent SNF visit, moderate", modifiers: [], units: 1, charge: 14200, pos: "31" }, ], icd: [{ code: "A41.9", description: "Sepsis, unspecified organism", primary: true }], amount: 14200, noteExcerpt: "Recovering from urosepsis. Afebrile x72h. Completing IV antibiotic course. Stable.", noteSignedBy: "Dr. Priya Shah, MD", noteSignedAt: "2026-05-20T17:52:00", submittedAt: "2026-05-20T18:20:00", acceptedAt: "2026-05-21T09:00:00", paidAt: "2026-06-08T00:00:00", paidAmount: 13640, arDays: 19, }, { id: "CLM-24699", status: "denied", patientName: "Frank Petrov", patientMrn: "PV-100133", dob: "1944-12-01", roomBed: "205-A", dateOfService: "2026-05-28", capturedAt: "2026-05-28T18:05:00", provider: "Dr. Amara Rivera, NP", providerNpi: "1487256390", payer: "Medicare Advantage", payerClass: "ma", memberId: "UHC•••1180", groupNumber: "SNF-CO-19", cpt: [{ code: "99310", description: "Subsequent SNF visit, high", modifiers: [], units: 1, charge: 18900, pos: "31" }], icd: [{ code: "I48.91", description: "Unspecified atrial fibrillation", primary: true }], amount: 18900, noteExcerpt: "New-onset rapid AFib with RVR, rate 140s. Started diltiazem drip, transitioned to PO. Rate controlled to 80s. High-complexity management with continuous monitoring.", noteSignedBy: "Dr. Amara Rivera, NP", noteSignedAt: "2026-05-28T18:02:00", submittedAt: "2026-05-29T09:00:00", arDays: 40, denial: { date: "2026-06-09", carc: "CARC 50", reason: "These are non-covered services because this is not deemed a 'medical necessity' by the payer for the billed visit complexity.", timelyFilingDeadline: "2026-08-27", }, }, ] // ---- Derived aggregates for the DON / admin dashboard --------------------- export function statusCounts(claims: Claim[]): Record { const base: Record = { draft: 0, submitted: 0, accepted: 0, denied: 0, paid: 0 } for (const c of claims) base[c.status]++ return base } // Displayed tab counts reflect the full facility book of business (spec values), // while the mock table shows a representative slice per tab. export const TAB_COUNTS: Record = { draft: 23, submitted: 41, accepted: 18, denied: 7, paid: 112, } export interface ArByPayer { payerClass: PayerClass label: string openAr: number // cents claims: number denialRate: number // 0..1 avgArDays: number } export const AR_BY_PAYER: ArByPayer[] = [ { payerClass: "medicare", label: "Medicare Part A / B", openAr: 41820000, claims: 47, denialRate: 0.05, avgArDays: 21 }, { payerClass: "ma", label: "Medicare Advantage", openAr: 68430000, claims: 39, denialRate: 0.12, avgArDays: 38 }, { payerClass: "medicaid", label: "Medicaid", openAr: 19260000, claims: 22, denialRate: 0.07, avgArDays: 29 }, ] export interface DenialTrendPoint { month: string rate: number // percent } export const DENIAL_TREND: DenialTrendPoint[] = [ { month: "Jan", rate: 14.2 }, { month: "Feb", rate: 13.1 }, { month: "Mar", rate: 12.4 }, { month: "Apr", rate: 10.8 }, { month: "May", rate: 9.3 }, { month: "Jun", rate: 8.1 }, ] export const KPIS = { submittedRevenueMonth: 24817000, // cents this month submittedRevenueDelta: 0.12, openArTotal: 129510000, openArDelta: -0.08, denialRate: 0.081, denialRateDelta: -0.052, daysInAr: 27, daysInArDelta: -0.15, chargeCaptureRate: 0.962, firstPassAcceptance: 0.913, } [V0_FILE]typescriptreact:file="components/billing/billing-sidebar.tsx" isMerged="true" "use client" import { useState } from "react" import { Home, Users, FileText, ReceiptText, Settings, Menu, X, Activity } from "lucide-react" import { cn } from "@/lib/utils" const NAV = [ { label: "Home", icon: Home, key: "home" }, { label: "Patients", icon: Users, key: "patients" }, { label: "Notes", icon: FileText, key: "notes" }, { label: "Billing", icon: ReceiptText, key: "billing" }, { label: "Settings", icon: Settings, key: "settings" }, ] as const function NavList({ onNavigate }: { onNavigate?: () => void }) { return ( ) } function Brand() { return (

Carebrain

SNF Billing

) } export function BillingSidebar() { const [open, setOpen] = useState(false) return ( <> {/* Mobile top bar */}

Carebrain

{/* Desktop rail */} {/* Mobile drawer */} {open && (

setOpen(false)} aria-hidden />

setOpen(false)} />

)} ) } [V0_FILE]typescriptreact:file="components/billing/metrics-overview.tsx" isMerged="true" "use client" import { TrendingDown, TrendingUp, ArrowRight } from "lucide-react" import { Card } from "@/components/ui/card" import { cn } from "@/lib/utils" import { AR_BY_PAYER, DENIAL_TREND, KPIS, PAYER_META, fmtUsd } from "@/lib/billing-data" function pct(n: number, digits = 0) { return `${(n * 100).toFixed(digits)}%` } function Delta({ value, goodWhenDown = false }: { value: number; goodWhenDown?: boolean }) { const down = value < 0 const good = goodWhenDown ? down : !down const Icon = down ? TrendingDown : TrendingUp return ( {value > 0 ? "+" : ""} {pct(value, 0)} ) } function KpiCard({ label, value, delta, goodWhenDown, hint, }: { label: string value: string delta: number goodWhenDown?: boolean hint: string }) { return (

{label}

{value}

{hint}

) } function DenialTrend() { const rates = DENIAL_TREND.map((d) => d.rate) const max = Math.max(...rates) const min = Math.min(...rates) const range = max - min || 1 const w = 100 const h = 40 const step = w / (rates.length - 1) const points = rates.map((r, i) => { const x = i * step const y = h - ((r - min) / range) * (h - 6) - 3 return `${x},${y}` }) const last = DENIAL_TREND[DENIAL_TREND.length - 1] return (

Denial rate trend

{last.rate.toFixed(1)}%

Target ≤ 8%

{DENIAL_TREND.map((d) => ( {d.month} ))}

) } function ArByPayer() { const max = Math.max(...AR_BY_PAYER.map((p) => p.openAr)) return (

Open AR by payer

{fmtUsd(KPIS.openArTotal)}

{p.label} {fmtUsd(p.openAr)} · {p.avgArDays}d avg

{pct(p.denialRate)} den.

e.preventDefault()} className="mt-3 inline-flex items-center gap-1 text-xs font-semibold text-primary hover:underline focus-visible:outline-none focus-visible:ring-2 focus-visible:ring-ring rounded" > View multi-facility rollup ) } export function MetricsOverview() { return (

) } [V0_FILE]typescriptreact:file="components/billing/appeal-dialog.tsx" isMerged="true" "use client" import { useEffect, useState } from "react" import { Sparkles, FileText, Send } from "lucide-react" import { Dialog, DialogContent, DialogDescription, DialogFooter, DialogHeader, DialogTitle, } from "@/components/ui/dialog" import { Button } from "@/components/ui/button" import { Textarea } from "@/components/ui/textarea" import { Spinner } from "@/components/ui/spinner" import { type Claim, fmtDate } from "@/lib/billing-data" function buildAppeal(claim: Claim): string { const primary = claim.icd.find((i) => i.primary) ?? claim.icd[0] const cpt = claim.cpt[0] return `RE: Appeal of Claim ${claim.id} — ${claim.patientName} (Member ${claim.memberId}) Date of Service: ${fmtDate(claim.dateOfService)} Denial: ${claim.denial?.carc}${claim.denial?.rarc ? ` / ${claim.denial.rarc}` : ""} To Whom It May Concern: We respectfully appeal the denial of the above claim. The billed service (CPT ${cpt.code} — ${cpt.description}) was medically necessary and supported by the attending clinician's signed encounter note dated ${fmtDate(claim.noteSignedAt)}. Clinical justification: The patient presented with ${primary.description} (${primary.code}). Per the documented encounter: "${claim.noteExcerpt.trim()}" This documentation establishes the medical necessity and complexity of the visit level billed. We request reprocessing and payment of this claim. Supporting clinical records from Carebrain are attached. Sincerely, ${claim.provider} NPI ${claim.providerNpi} · Pine Valley SNF` } export function AppealDialog({ claim, open, onOpenChange, }: { claim: Claim | null open: boolean onOpenChange: (v: boolean) => void }) { const [drafting, setDrafting] = useState(true) const [text, setText] = useState("") const [submitted, setSubmitted] = useState(false) useEffect(() => { if (open && claim) { setDrafting(true) setSubmitted(false) setText("") const t = setTimeout(() => { setText(buildAppeal(claim)) setDrafting(false) }, 900) return () => clearTimeout(t) } }, [open, claim]) if (!claim) return null return (