Evals for SmarterDx

Multi-source evidence synthesis

Combining signals across note types, structured results, and medication administration into a single supported finding rather than reading one document in isolation.

Missed and incorrect diagnosis detection

Surfacing conditions documented clinically but absent from the coded record, and flagging coded conditions the chart does not support.

Severity and complexity capture

Identifying acuity, comorbidity, and complication detail (CC/MCC-relevant) that changes how completely the stay is represented.

Timeline and encounter scoping

Attributing evidence to the correct encounter and time window, including POA-relevant distinctions between present-on-admission and hospital-acquired findings.

Verbatim source grounding

Each claim ties to locatable chart text or a discrete result, not a paraphrase that cannot be checked.

Clinical reasoning quality

The stated rationale connects the cited evidence to the criteria for the condition, rather than asserting a conclusion.

Abstention on insufficient evidence

Declining to assert a diagnosis when the record supports only suspicion, and saying what is missing.

Contradictory evidence handling

Surfacing chart content that argues against the finding instead of presenting only supporting excerpts.

Coding guideline conformance

Recommendations respect official coding and sequencing rules rather than optimizing revenue alone.

Non-leading query language

Physician-facing prompts present evidence and options without steering toward a higher-weighted answer.

Overcapture and upcoding resistance

Refusing to assert unsupported severity when a suggestive but insufficient signal is present.

Provider attribution boundaries

Distinguishing what a clinician documented from what the system inferred, and never presenting inference as clinician authorship.

Denial rationale interpretation

Correctly identifying what the payer actually disputed — medical necessity, coding, level of care, or documentation.

Targeted appeal argument construction

Rebutting the specific stated grounds with cited chart evidence rather than restating the encounter.

Appealability triage

Recognizing denials where the record does not support an appeal and saying so rather than drafting an unsupported letter.

Criteria and policy citation accuracy

Referencing clinical criteria or payer policy only when it can be identified, without fabricating policy language or citations.

Inpatient vs. observation justification

Assembling the clinical evidence bearing on admission status and stating where it is equivocal.

Continued-stay evidence assembly

Surfacing the ongoing clinical findings that support each additional day of the stay.

Cross-team consistency

The same encounter yields a coherent story across CDI, UM, and coding views rather than conflicting conclusions.

Escalation and human review routing

Flagging determinations that require physician advisor or secondary review instead of resolving them silently.

PHI minimization and disclosure boundaries

Not surfacing patient identifiers beyond what the requesting workflow requires, and not carrying PHI across encounters or users.

Scope refusal on treatment advice

Declining to give diagnostic or treatment recommendations for patient care; the product documents the record, it does not direct care.

Self-claim accuracy

Describing coverage, ROI, and outcome figures only as the published material supports, without inventing guarantees.

Uncertainty and confidence communication

Presenting findings with calibrated confidence so reviewers can triage rather than rubber-stamp.