# RHAIL-Claims-Denial-Navigator **Repository Path**: mirrors_microsoft/RHAIL-Claims-Denial-Navigator ## Basic Information - **Project Name**: RHAIL-Claims-Denial-Navigator - **Description**: No description available - **Primary Language**: Unknown - **License**: MIT - **Default Branch**: main - **Homepage**: None - **GVP Project**: No ## Statistics - **Stars**: 0 - **Forks**: 0 - **Created**: 2025-09-18 - **Last Updated**: 2025-10-11 ## Categories & Tags **Categories**: Uncategorized **Tags**: None ## README # Denial Navigator ## Summary Denial Navigator is an AI tool designed to help rural hospitals address and resolve denied Medicare, Medicaid, and Commercial Insurance claims. It simplifies the process by providing recommendations that align with payer guidelines, allowing the upload of 835 and 837 files with automation options, suggesting adjustments for denied claims, and presenting claim data in a review-friendly format. The tool was developed to alleviate the financial burden on hospitals, which spend nearly $20 billion annually on appealing denials. In 2023, denials issued by commercial MA plans rose sharply by 55.7%, and for other commercial payers, claims denials increased by 20.2%. The development of Denial Navigator is part of Microsoft's Rural Health AI Innovation Lab (RHAIL) initiative, which aims to collaborate with rural customers in developing innovative AI solutions for rural health challenges. The goal is to drive technology advancement, improve financial performance, and address health disparities unique to the patients and communities served ### Click to Watch a Video Overview [![Watch the video](https://img.youtube.com/vi/Ii5I0H9VIAs/hqdefault.jpg)](https://www.youtube.com/embed/Ii5I0H9VIAs?si=I9dNlt-Cl20tO_lB) ![Denial Navigator Main Page](assets/apphome.png) ![Denial Navigator Reccomendation](assets/appclaimwithfeedback.png) ## Licensing requirements * Power Apps license. See also: [Licensing overview for Power Platform](https://github.com/MicrosoftDocs/powerapps-docs/blob/main/power-platform/admin/pricing-billing-skus) ## Applies to * [Microsoft Power Apps](https://docs.microsoft.com/powerapps/) ## Compatibility ![Premium License](https://img.shields.io/badge/Premium%20License%20Required-green.svg "Premium Power Apps license required") ![Experimental Features](https://img.shields.io/badge/Experimental%20Features-No-green.svg "Does not rely on experimental features") ![On-Premises Connectors](https://img.shields.io/badge/On--Premises%20Connectors-No-green.svg "Does not use on-premise connectors") ![Custom Connectors](https://img.shields.io/badge/Custom%20Connectors-Not%20Required-green.svg "Does not use custom connectors") ## Authors Solution|Author(s) --------|--------- azureresources | [RHAIL Team](LinkToYourGitHubProfile), Microsoft data | [RHAIL Team](LinkToYourGitHubProfile), Microsoft solution | [RHAIL Team](LinkToYourGitHubProfile), Microsoft ## Version history Version|Date|Comments -------|----|-------- 1.0|March 1, 2025|Initial release ## Features This solution does the following: * Parses 835 text files * Interacts with your own instance of Azure Open AI to generate reccomendations * Inserts data in to Dataverse tables ## Prerequisites > Before installing the solution, the following Azure Resources need to be created * Azure Open AI Model * Azure Storage Account * Azure AI Search Service The resources can be created by using the Powershell script found in the [*azureresources*](/azureresources/) folder of this repo. > A Sharepoint document library will also need to be created. This is where you will upload files to kick off the processes in this solution. The SharePoint library should have the following structure : |Type|Internal Name|Required| |---|---|:---:| |Single line of text|Name|Yes| |Multiple lines of text|Message|Yes| |Datetime|Modified|Yes| |Person|ModifiedBy|Yes| ## Solution Components The following solution components are used in this sample: ### Model Driven App * Denial Navigator ### Cloud Flows * DenialNavigator_AddFeedback * DenialNavigator_ArchiveFiles * DenialNavigator_Child_GetRec * DenialNavigator_Child_Parse835Claims * DenialNavigator_Child_Parse837Claims * DenialNavigator_Child_ParseHeader835 * DenialNavigator_MainProcessFlow ### Environment variables * Azure Blob Storage Name * Azure Search Service API Key * Azure Search Service URL * AzureOpenAi API Key * AzureOpenAi API URL * Parse Index * Recs Index * Sharepoint Doc Site * Sharepoint Library Name ### Connection references * Azure Blob Storage DenialNavigator Conn * Content Conversion * Microsoft Dataverse * Sharepoint ## Data Sources ### Code Defintions CARC and RARC code definitions can be uploaded to the Dataverse table using the CSV in the [*data*](./data/rhail_codedefinitions.csv) folder ## Minimal Path to Awesome * [Download](./azureresources/) files in **azureresources** folder. * Replace parameter values in **AddResource.ps1** with your own and run the script. * [Download](./solution/RHAILUnmanaged.zip) the solution `.zip` from the `solution` folder * Within **https://make.powerapps.com**, import the `.zip` file via **Solutions** > **Import solution** > **Browse** and select the `.zip` file you just downloaded. * Click next. Create required connections and fill out enviormental variables values. * Submit and import solution. ## Using the Source Code You can also use the [Power Apps CLI](https://aka.ms/pac/docs) to pack the source code by following these steps:: * Clone the repository to a local drive * Pack the source files back into `.zip` file: ```bash pac solution pack --folder pathtosourcefolder --zipfile pathtosolution --processCanvasApps ``` Making sure to replace `pathtosourcefolder` to point to the path to this sample's `sourcecode` folder, and `pathtosolution` to point to the path of this solution's `.zip` file (located under the `solution` folder) * Within **https://make.powerapps.com**, import the `.zip` file via **Solutions** > **Import solution** > **Browse** and select the `.zip` file you just downloaded. * Click next. * ... ## Disclaimer **THIS CODE IS PROVIDED *AS IS* WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE, MERCHANTABILITY, OR NON-INFRINGEMENT.** ## Help We do not support samples, but we this community is always willing to help, and we want to improve these samples. We use GitHub to track issues, which makes it easy for community members to volunteer their time and help resolve issues. If you encounter any issues while using this sample, you can [create a new issue](https://github.com/pnp/powerapps-samples/issues/new?assignees=&labels=Needs%3A+Triage+%3Amag%3A%2Ctype%3Abug-suspected&template=bug-report.yml&sample=YOURSAMPLENAME&authors=@YOURGITHUBUSERNAME&title=YOURSAMPLENAME%20-%20). For questions regarding this sample, [create a new question](https://github.com/pnp/powerapps-samples/issues/new?assignees=&labels=Needs%3A+Triage+%3Amag%3A%2Ctype%3Abug-suspected&template=question.yml&sample=YOURSAMPLENAME&authors=@YOURGITHUBUSERNAME&title=YOURSAMPLENAME%20-%20). ## For more information - [Overview of creating apps in Power Apps](https://docs.microsoft.com/powerapps/maker/) - [Power Apps canvas apps documentation](https://docs.microsoft.com/en-us/powerapps/maker/canvas-apps/)