Encore OS — Documentation

Version: 1.2.0
Last Updated: 2026-02-22
Status: ✅ Implemented
Last Verified: 2026-02-22 Spec: PM-11 Revenue Cycle Dashboard & Analytics
Constitution Reference: Section 1.2 (Core Independence), Section 1.3 (Integration Patterns)

Overview

PM-11 owns the revenue cycle dashboard and analytics: KPI dashboard (days in A/R, clean claim rate, denial rate, collection rate, charge lag), A/R aging, denial analysis, payer mix, provider productivity, service line profitability, charge capture completeness, and report scheduling via PF-12 (Phase 2).

Integration Points (from spec)

Dependency	Pattern	Purpose	Status
PM-07	Data (same core)	Source data for RCM metrics (charges, encounters)	✅ Available
PM-08	Data (same core)	Claims data for clean claim rate, denial rate, claim lag	✅ Available
PM-09	Data (same core)	Payment posting for collection rate, payment lag	✅ Available
PM-10	Data (same core)	Authorization utilization and trends	✅ Available
PF-12	Platform Layer	Report generation engine; configurable scheduling and distribution	⏳ Deferred to Phase 2
FA-07	Platform Layer / API	Financial reporting integration	📋 Future

Data Source Tables

Table	Key Columns for PM-11	Used By
`pm_charges`	`service_date`, `charge_amount`, `status`, `encounter_id`, `created_at`	Days in A/R, Charge Lag, Collection Rate
`pm_claims`	`status`, `total_charge`, `paid_amount`, `adjustment_amount`, `submitted_at`, `adjudicated_at`, `denial_codes`	Clean Claim Rate, Denial Rate, Net Collection Rate, Claim Lag
`pm_claim_lines`	Per-line detail	Service Line Profitability
`pm_payments`	`payment_date`, `total_amount`, `posted_amount`, `payer_id`, `patient_id`	Collection Rate, Payer Mix, Payment Lag
`pm_payment_applications`	Claim-to-payment linkage	Payment Lag, Net Collection Rate
`pm_encounters`	`encounter_date`, `status`, `charge_captured_at`	Charge Lag, Provider Productivity
`pm_prior_authorizations`	`status`, `approved_units`, `used_units`	Authorization Utilization
`pm_payers`	Payer details	Payer Mix

Note: pm_adjustments table does NOT exist. Adjustments are stored as pm_claims.adjustment_amount and as CARC group code entries in pm_payment_applications.

Metric Type Values

The following metric_type values are used in pm_rcm_snapshots and pm_rcm_benchmarks:

metric_type	Description	Refresh Frequency
`days_in_ar`	Days in Accounts Receivable	Daily
`clean_claim_rate`	Claims accepted on first submission %	Weekly
`denial_rate`	Denied claims %	Weekly
`collection_rate`	Collected / Allowed amount %	Monthly
`net_collection_rate`	Payments / (Charges - CO adjustments) %	Monthly
`first_pass_resolution_rate`	Claims paid without rework %	Weekly
`charge_lag_days`	Avg days from service to charge entry	Weekly
`claim_lag_days`	Avg days from charge to claim submission	Weekly
`payment_lag_days`	Avg days from submission to payment	Weekly
`payer_mix`	Revenue by payer category %	Monthly

Dimensions JSONB Shape

// Example dimensions for a snapshot record
{
  "payer_id": "uuid-of-payer",      // optional
  "service_line": "iop",            // optional: iop, php, residential, outpatient
  "provider_id": "uuid-of-provider", // optional
  "site_id": "uuid-of-site"          // optional
}

Dimensions vary by metric_type. Not all dimensions apply to all metrics.

PF-12 Integration (Phase 2 — Deferred)

Status: ⏳ Deferred — PF-12 tables exist (pf_reports, pf_report_schedules, pf_report_runs) but no API contract is defined for PM-11 to register reports with PF-12. When implemented:

PM-11 will register snapshot-based reports with PF-12 for scheduled generation and distribution
Document the exact API or data contract in this file and in API_CONTRACTS.md
US5 in the spec will be undeferred

Event / API Contracts

PM-07/08/09/10: Dashboard and snapshots read from PM tables (pm_charges, pm_claims, pm_payments, authorization data); no new event contracts; data accessed via same core.
PF-12: Deferred to Phase 2. See section above.
FA-07: When integrated, document in API_CONTRACTS.md or EVENT_CONTRACTS.md.

Events Consumed

`pm_cost_estimate_generated` (from PM-48)

Publisher: PM-48 (Patient Cost Estimation & Financial Clearance)
Event Name: pm_cost_estimate_generated
Version: 1.0

Payload Schema:

{
  estimate_id: string;
  patient_id: string;
  organization_id: string;
  patient_estimated_responsibility: number;
  service_type: string;
}

Subscription Rules: Unconditional — all estimates feed into clearance metrics
Delivery Semantics: At-least-once; idempotent processing via estimate_id
ACL/Topic: pm.cost_estimates topic
Purpose: Feed clearance metrics into PM-11 dashboard (US-3: clearance completion rate, avg days to clearance, avg patient responsibility)
Status: 📝 Planned

Integration Matrix

From	To	Pattern	Status	Doc
PM (PM-11)	PM-07, PM-08, PM-09, PM-10	Data (same core)	✅ Available	This doc
PM (PM-11)	PF-12	Platform Layer (reports)	⏳ Phase 2	This doc
PM (PM-11)	FA-07	Platform Layer / API (future)	📋 Future	TBD

References

Integration Documentation: PM-49 — Revenue Cycle Automation Rules Engine Revenue Recognition (Advanced) — Integration

Start Here

Module Engineering Snapshots

Canonical AI Governance

Architecture

Integrations

Development

Decision Guides

Database

Module Reference

Testing

Migration

Operations

Governance & Security

Platform Internals

Revenue Cycle Dashboard & Analytics — Integration

Overview

Integration Points (from spec)

Data Source Tables

Metric Type Values

Dimensions JSONB Shape

PF-12 Integration (Phase 2 — Deferred)

Event / API Contracts

Events Consumed

`pm_cost_estimate_generated` (from PM-48)

Integration Matrix

References

​Overview

​Integration Points (from spec)

​Data Source Tables

​Metric Type Values

​Dimensions JSONB Shape

​PF-12 Integration (Phase 2 — Deferred)

​Event / API Contracts

​Events Consumed

​pm_cost_estimate_generated (from PM-48)

​Integration Matrix

​References

Overview

Integration Points (from spec)

Data Source Tables

Metric Type Values

Dimensions JSONB Shape

PF-12 Integration (Phase 2 — Deferred)

Event / API Contracts

Events Consumed

`pm_cost_estimate_generated` (from PM-48)

Integration Matrix

References