# DenQAI: payer performance review

File-specific companion · 2026-09-10

## Purpose

How do payer-segment cash, outstanding balances, and administrative burden compare for one period?

**Who:** Billing manager, owner, and qualified contract reviewer

**Records:** Authorized aggregate expected allowed amounts; insurance/patient payments; denials; outstanding balances; time records; current contract locator.

## Complete the file

1. Use coded_payer_segment and period with a consistent network_source.
2. Enter expected allowed, insurance payments, patient payments, denied amount, and outstanding amount separately.
3. Record administrative_hours and credentialing burden, then verify evidence_status and limitations before deciding next_action.

## Definitions

- **Expected allowed amount:** Aggregate amount expected under the specified product and terms, subject to verification.
- **Outstanding amount:** Amount unresolved at the stated cutoff, with a defined balance basis.
- **Administrative hours:** Measured or explicitly assumed staff time for the stated segment and period.

## Fictional example

Fictional example: PAYER-A has $40,000 expected allowed and $6,000 outstanding at month end; review timing and denials before labeling the difference a loss.

## Review and next action

Reconcile one material shortfall or burden to its actual cause before changing a participation assumption.

The CSV does not establish recoverability, underpayment, or patient responsibility. Do not sum fields whose timing or overlap is undefined.

[Related DenQAI guide](https://denqai.com/insurance)

## AI coach prompt

Help me use DenQAI’s payer performance review. My question is: How do payer-segment cash, outstanding balances, and administrative burden compare for one period? Explain these terms in plain language: Expected allowed amount, Outstanding amount, Administrative hours. Ask one question at a time about the required records: Authorized aggregate expected allowed amounts; insurance/patient payments; denials; outstanding balances; time records; current contract locator. Walk through the supplied fictional example before asking me for inputs. Treat every missing value as unknown, not zero. Do not invent source records, contract terms, legal conclusions, or clinical facts. Use only permitted fictional or aggregate, non-identifying information. Follow this boundary: The CSV does not establish recoverability, underpayment, or patient responsibility. Do not sum fields whose timing or overlap is undefined. End with the missing evidence and this next step: Reconcile one material shortfall or burden to its actual cause before changing a participation assumption.

## AI review prompt

Review my permitted fictional or aggregate draft of DenQAI’s payer performance review against the file instructions. Check each required field and period, units, evidence locator, assumptions, arithmetic where formulas are actually supplied, and unresolved contradictions. Check the sequence: Use coded_payer_segment and period with a consistent network_source. Enter expected allowed, insurance payments, patient payments, denied amount, and outstanding amount separately. Record administrative_hours and credentialing burden, then verify evidence_status and limitations before deciding next_action. Separate facts from assumptions and missing records. Do not supply unsupported numbers or make a professional decision for me. Apply this limitation: The CSV does not establish recoverability, underpayment, or patient responsibility. Do not sum fields whose timing or overlap is undefined. Return corrections, questions for the responsible reviewer, and the next action.