otlen.site Rev 2026.10

OTLEN / ProjectsCampaigns and individual projects

What OTLEN is actually building.

A project board in public: focused systems, prototypes, launches, and the reasoning behind them.

A company can describe itself with a sentence. Its projects show what that sentence actually means. This site documents work at the level of concrete problems, systems, interfaces, and outcomes.

The problems are in revenue operations: denials, underpayments, charge capture and prior authorization in health systems, and the revenue that leaks between a clinic’s point of sale and its EMR.

Property
otlen.site
Stages
Map, prototype, launch, case study, archive
Examples
Health system, med spa group
Revision
2026.10
  1. 01 Workflow mapThe current state, drawn
  2. 02 PrototypeClose enough to be real
  3. 03 LaunchOperate, then measure
  4. 04 Case studyThe before state, honestly
  5. 05 ArchivePatterns across projects

01 / 05Workflow projects

Every project starts with a specific operational pain.

Projects start with a specific operational pain. The first deliverable is often a map of the current workflow.

  1. 1Duplicated data entry
  2. 2Slow lead routing
  3. 3Missed follow-ups
  4. 4Disconnected systems
  5. 5Manual reconciliation
  6. 6Poor visibility

The map shows who touches the work, in which system, in what order, and where each pain sits. Switch between a health system and a med spa group: the lanes change, the six pains do not.

Current-state map

    Example workflow, drawn from how this work commonly runs. Not a client engagement.

    The before state, in public numbers

    Five of the six pains are already measured in public.

    Premier Inc. · 516 hospitals · 2022 claims

    $19.7billion
    a year

    spent by providers fighting denials, by Premier’s estimate.

    CAQH Index 2025

    $18.7billion
    a year

    the medical industry could still save by moving administrative transactions to fully electronic.

    1. 1Duplicated data entry

      $8.03per manual transaction

      A manual transaction cost medical providers $8.03 on average, against $2.65 when fully electronic.

      CAQH Index 2025

    2. 2Slow lead routing

      Not published

      No public benchmark. Each project measures its own: time from inquiry to first reply, by location.

      Measured per project

    3. 3Missed follow-ups

      54.3%overturned and paid

      of private-payer denials were ultimately overturned and paid. A denial nobody follows up forfeits that chance.

      Premier Inc. · 2022 claims

    4. 4Disconnected systems

      40%fully electronic

      of prior authorizations ran fully electronic for medical plans in 2025. The rest went partly or fully by portal, phone or fax.

      CAQH Index 2025

    5. 5Manual reconciliation

      78%fully electronic

      of claim payments were fully electronic for medical plans in 2025. The rest needed manual steps before they could be matched.

      CAQH Index 2025

    6. 6Poor visibility

      11.81%initial denials, 2024

      initial denial rate across more than 2,100 hospitals, up from 10.15% in 2020. A rate means something only next to the right peers.

      Kodiak Solutions · May 2025

    02 / 05Prototypes

    Close enough to reality to reveal the hard parts.

    The prototype should be close enough to reality to reveal the hard parts.

    A clickable screen, a webhook flow, a focused agent, or a data pipeline can teach more in a day than a long specification.

    Four forms, one project: routing a health system’s denied claim lines to the people who can fix them. Each plate names the hard part its form exposed.

    Form A · Clickable screen
    Example screen · denial worklist
    CARCReasonPayerAgeRoute
    197Authorization absentCommercial12 dAuth team
    16Missing informationMedicare Adv.4 dCoding
    45Exceeds fee scheduleCommercial21 dContracts
    50Not medically necessaryMedicaid MCO9 dClinical review
    The hard part it revealedWhether a biller can act on a row without opening three other systems.
    Form B · Webhook flow

    POST /events/remit

    event
    remit.line.denied
    source
    835 remittance · clearinghouse
    segment
    CAS*CO*197
    reason
    CARC 197 · authorization absent
    remark
    RARC M62 · authorization code missing
    key
    CLP07 + REF*6R · applied once
    route
    → authorization queue
    The hard part it revealedPayers resend remits and reverse claims (CLP status 22). Each line has to be applied once, in order.
    Form C · Focused agent

    Inputs

    • Denied line, CARC 197
    • Scheduling record
    • Fax inbox
    • Payer authorization rules

    Task

    Find the authorization that was obtained, if one exists.

    Outputs

    • Authorization number and its source document
    • Match confidence
    • Corrected claim, held for a biller’s sign-off
    The hard part it revealedKnowing when not to answer. A weak match goes to a person with the evidence attached.
    Form D · Data pipeline
    835 remitstrace in TRN02 BAI2 depositsEFT trace Match on TRNelse amount + date Postedautomatic Exceptionsowner + reason
    The hard part it revealedOne deposit can pay many claims. When the TRN trace number is missing, matching falls back to amount and date.

    03 / 05Launches

    From proving the idea to operating it.

    When a project becomes reliable enough to expose to users, the work shifts from proving the idea to operating it.

    Onboarding, monitoring, analytics, support, documentation, and measurable outcomes. Each one gets a definition and a measure before go-live, written here for the denial-routing project.

    Proving the ideaOperating it

    1. Onboarding

      Each location’s payers, CARC routing rules and owners loaded before go-live.

      locations live ÷ locations planned

    2. Monitoring

      Every 835 file accounted for: received, parsed, routed. A missing file raises an alert the same day.

      files parsed ÷ files received, daily

    3. Analytics

      Open denials by CARC, payer, age and owner, every morning.

      open denial balance over 30 days

    4. Support

      Every exception has a named owner and a due date set from the payer’s appeal window.

      exceptions without an owner, target none

    5. Documentation

      Routing rules written down and versioned, with the reason for each change.

      rule changes with a recorded reason

    6. Measurable outcomes

      Initial denial rate, overturn rate, days to appeal and cost to work a denial, read against the public baselines above.

      denials overturned ÷ denials appealed

    04 / 05Case studies

    The most useful case study explains the before state honestly.

    What was manual? Where did errors happen? What changed? Which parts were automated? Which parts intentionally stayed human? What trade-offs appeared?

    Here is the same workflow from 01 after the project. Removed steps stay on the map, struck through, so the change is visible.

    • Automated
    • Stays human, by design
    • Unchanged
    • Removed
    After-state map

      Example case study. Illustrative, not a client engagement.

      05 / 05The project archive

      The patterns across projects are the real asset.

      Over time this becomes a record of the company’s engineering and product judgment, not just a collection of launch announcements.

        Project types × recurring patternsEditorial map
        The project types OTLEN takes on, against the patterns each one needs. An editorial mapping, not usage statistics. The most-shared pattern is marked.

        The project is the proof.

        This is an editorial starting point, designed to grow with original articles, projects, research, tools, examples, and case studies specific to this property.

        Sources for the public numbers

        1. Premier Inc., Trend alert on private payer denialsMar 21, 2024. 516 hospitals in 36 states, 2022 claims.
        2. CAQH, 2025 CAQH Index Executive ReportMedical plans and providers: adoption, cost per transaction and savings.
        3. Kodiak Solutions, revenue cycle benchmarksMay 21, 2025. More than 2,100 hospitals.

        Workflow maps, screens and case-study answers are examples. The pattern map is editorial.