Feature Specification List


  • Electronically scans and imports record request data from requestor letters
  • Automatically checks if claim was previously requested or excluded from audit
  • RAC Site Monitoring and Data Collection
  • FISS System Monitoring and Data Collection
  • Commercial portal monitoring, data Collection and Document Submission
  • Pre-Bill Audit tracking and support

AuditNavigator™ Reporting

  • Activity dashboards
  • Financial in-process reporting
  • DRG revision
  • Data integrity analysis
  • Recovery rate
  • EHR status report
  • Request status summary
  • Claim issue listing
  • Appeal status
  • Management summary
  • Ad hoc Reporting


  • Rules based denial triggering engine with the ability to set rules based on 18 variables
  • Sophisticated and flexible Workflow design
  • Automated Workflow and work list assignment
  • Ability for multiple users to work on a single claim based on Reason code simultaneously
  • Set triggers based on Primary vs Secondary payer
  • User defined Actionable vs Nonactionable and Technical vs Clinical reason Codes
  • Interface with Cerner, Epic… for return notes
  • Supports denials at the header and line level
  • Utilizes facility defined tables
  • Facility defined reason code reporting categories

DenialsNavigator™ Reporting

  • Denial dashboards
  • Root cause analysis/department/disposition
  • Payer denial analysis
  • Denial reporting by Group Codes
  • Recovery/Denial/KPI trending
  • Corporate level rollup reporting for multi facility, clinic and physician group entities

Shared Modules

  • Tracking and Management

    • User configurable (payers, audit type, events, issues, time frames, custom fields)
    • User-specified workflow (tasks, responsible person, alerts)
    • Appeal Type Sensitive Workflows (medical necessity, coding, etc.)
    • Historical claim database for easy data entry (up to 4 years of claims history)
    • Retrieve data from claim history database to minimize data entry
    • Task work list by user
    • Document repository (upload and attach document in pdf, doc, xls format to request or claim)
    • esMD –Electronic Medical Record Submission to participating CMS contractors (MAC, RAC, etc.)
    • Electronically transmit medical records, appeal letters and correspondence via efax, payer portals, secure email and SFTP
    • Attach comments to request or claim
    • Appeal letter templates populated with data from system database
    • Task status dashboard with drilldown to individual claims
    • Generate CD/DVD containing requested medical records
    • Supports most all audit/appeals types (Commercial, RAC, Medicaid, CMS, ZPIC, ADR, PrePay, etc.)
    • Pre-Bill Audit tracking and support

  • Executive Health Resources

    • Electronic Document and Information Exchange – Platinum Level Approved for all EHR appeals
    • Auto-populates EHR required documents
    • Automatically updates document status from EHR system (appeal levels, denials, etc.)

  • Reporting

    • Activity Dashboards
    • Financial In-Process Reporting
    • Summary by DRG
    • Data Integrity Analysis
    • Denial Recovery Rate
    • EHR Status Report
    • Request Status Summary
    • Claim Issue Listing
    • Appeal Status
    • Management summary
    • Ad hoc Reporting

  • Automated Interfaces

    • Populate provider system with AuditNavigator™/DenialsNavigator™ data
    • Receive accounting, contract and medical coder data from provider system


The Wellington Group, LLC
6133 Rockside Rd, Suite 205
Independence, OH 44131
Phone: 216.525.2200
Fax: 216.525.2201
Schedule an online demonstration