Business Intelligence Reporting for Claims Data

Normalized data

Drill down capabilities

Dashboard views

EDI + appealed claims data

Real-time business intelligence

Common Claims Data Challenges

  • Do you need comprehensive data to improve your claims process?
  • Is your 835 and 837 claims data mapped to each corresponding claim?
  • Does the EDI data tie to your claims review system and create visual trends?

Then Optics is your solution.

Optics transforms claims data into actionable insights

Optics combines data and healthcare expertise to deliver real-time business intelligence reporting on claims information that historically has been inaccessible. Our normalized platform leverages EDI X12 and appealed claims data to provide holistic insight into your organization’s denied claim trends. Optics then delivers immediate report access from desktop or mobile – with instant, drill down capabilities – specific to your requested business needs.

Optics business intelligence reporting benefits areas including:

  • Patient Financial Services (PFS)
  • Care Management
  • Revenue Cycle


Comprehensive Technology

Access normalized data from previously siloed sources

Healthcare Expertise

Outsource the data and reporting set-up process with minimal internal resources

Customized Reporting

Choose how to see the data trends based on each department’s needs

Client Solutions Example

For a hospital facing an increase in coding inaccuracies, the revenue cycle management team can benefit from a dashboard of downcoding data by payer with drill down capabilities that is accessible in real-time – even from an app!

Check out this Optics example of a customized dashboard solution that this hospital’s finance staff could access and utilize in weekly departmental meetings. As users click into the data, it details:

  • Targeted codes

  • Payers performed downcoding

  • DRGs targeted by specific payers

  • Appeal success per payer, place of service, or code assigned


What is a data lake?

A data lake is a centralized system of both structured and unstructured data that allows our team to aggregate claim appeal data from data streams (multiple data sources) and normalizes data into visual, customizable reports.


Comprehensive Technology

Our technology is built on a centralized AWS supported data lake platform to combine real-time 835i/837i and appeal/denial data from all of your data sources. We integrate this data repository with our healthcare expertise to normalize the right data so your revenue cycle management teams can create accurate reports providing a visual landscape into your denial trends – empowering your team to make confident decisions regarding your claims management process.


Healthcare Expertise

We are not only a healthcare technology company but one who specializes in the claims management process. We’ve combined our years of denial management experience with the latest technologies to develop a comprehensive reporting solution for you – one that we utilize internally to manage our business.

To help ensure your success with Optics, we assign one of our data and reporting experts to your account as a Business Solutions Architect (BSA).

Who is a BSA?

Learns your business, data sources, and reporting objectives

Liaises between your organization and our clinical coding SMEs

Delivers business intelligence reports in a framework of easy-to-navigate dashboards

Why Optics?

Customize this flexible, real-time reporting and analytics framework to fit your organization’s needs. Plus, benefit from:

  • Applying best practices from experienced data and denial management teams
  • Growing with scalability
  • Getting started with minimal internal resources


Customized Reporting

Optics delivers customized reporting solutions that transforms all claim and appeal data sources into a single data source. End-users have the ability to tailor data information, data frequencies, and viewing styles to customize reporting trends into one intuitive dashboard. All of your claims/denial data can be aggregated, analyzed, and benchmarked to assess your organization’s performance, and identify areas of improvement.