Arclight Readiness Navigator

appeal-economics

Compare hypothetical Medicare audit repayment and appeal-service costs, calculate break-even probabilities and fee ceilings, and assess quote scope. Use for appeal expected value, appeal budgets, or comparing fees. Uses explicit financial assumptions and sensitivity analysis; does not estimate actual win probability or set a market price.

appeal-pathway-outlook

Give an evidence-grounded readiness outlook for a de-identified Original Medicare fee-for-service audit or appeal across redetermination, QIC reconsideration, OMHA/ALJ, Appeals Council, and possible court review. Use when the user asks how far a case may need to go, what to prepare at each level, reversal likelihood, or whether specialist/counsel involvement is warranted. Do not invent precise odds or apply aggregate statistics without compatible denominators.

focused-appeal-response

Build or revise a focused reviewer-facing response framework from a de-identified Medicare readiness map for an ADR, audit finding, prepayment denial, redetermination, QIC reconsideration, or OMHA/ALJ issue. Use after the notice, record evidence, and current authority are mapped. Produces a working external draft and attachment plan without dumping the internal vulnerability memo into the submission. Do not use to fabricate facts, hide requested material information, or guarantee reversal.

medicare-notice-triage

Prepare a small practice or RCM team for a Medicare audit before a notice arrives, or triage a de-identified ADR, denial, overpayment, appeal, or WISeR notice into its program, deadlines, owners, and next steps. Also handles plugin support and questions about arranging human help. Use for readiness planning and notice routing, not a full evidence map, appeal draft, or outcome estimate.

rationale-drift-review

Compare abstracted or de-identified Medicare decisions to prepare for the next review stage by detecting changed, added, abandoned, fragmented, or inconsistently applied denial rationales. Use when the user has two or more reviewer decisions, multiple related claims, or says the reason for denial keeps changing. Do not use for a standalone evidence map or to claim procedural invalidity without authority.

record-risk-corrective-action

Create a candid internal-only readiness review from de-identified Medicare information, identifying documentation vulnerabilities, template or copy-forward problems, operational causes, corrective actions, and escalation needs. Use when a practice or RCM team wants to learn from an audit without automatically disclosing every weakness in the appeal. Do not use to conceal required facts, alter records, or draft the external response.

skin-substitute-evidence

Assess clinical literature and real-world evidence for a skin-substitute experimental or investigational denial. Distinguish direct studies, related-product trials, case series, regulatory assertions, policy, and patient applicability; build an evidence-readiness matrix and supported response positions. Includes a selected AmchoPlast reference pack, not a complete literature library or treatment selector.

wound-care-evidence-map

Build a de-identified wound-care evidence-readiness map for a Medicare audit or denial. Use for episode timelines, conservative-care history, wound measurements, product/application records, claim-line reconciliation, missing-evidence questions, and provider-validation lists. Do not use for a final appeal letter, legal conclusions, or invented clinical rationales.