Medical Claim Denial Analysis – RCM Toolkit

This project is built to help Medical Billing Analysts and RCM Teams gain insights from claim data to reduce denials and improve collections.

📌 Purpose

Analyze medical billing Excel data (CPT codes, insurance, payments, etc.) to:

• Identify top denied CPTs
• Diagnose root causes of non-payment
• Recommend fixes for coding and workflow
• Generate visual reports for easy stakeholder review

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📂 Features

✅ Analyze uploaded Excel file (e.g., billing_data.xlsx)
✅ Detect denial trends by:

• CPT Code
• Insurance Company
• Physician

✅ Flag root causes like:

• Modifier issues
• LCD/NCD mismatches
• NCCI edits
• Missing documentation or authorizations

✅ Recommend fixes:

• Modifier adjustments
• Claim resubmission/appeals
• Documentation and workflow improvements

✅ Generate:

• Summary reports
• Denial trend charts
• Heat maps

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🚀 How to Use

1. Clone this repository

2. Install requirements bash pip install -r requirements.txt

3. Run the Streamlit App bash streamlit run app.py

4. Upload your Excel file containing:

   • CPT Code
   • Insurance Company
   • Physician
   • Amount