A claim you were paid on is not a diagnosis CMS credited.
Between the claim your system paid and the revenue you were credited for sit several stages where a diagnosis can silently disappear — an internal rejection, a format rejection, a federal rejection, an acceptance that is nonetheless filtered out of risk adjustment. Most organizations can only see the last one.
The whole lifecycle, attributed to a member
Alberto tracks the encounter from the moment it leaves your systems to the moment it appears — or doesn’t — on the federal model output, including the pre-submission stages the federal status report never sees. Every stage is reconciled back to the originating claim and forward to what you were actually credited for.
Adjudication and the encounter trail are independent axes. A claim can be paid and never accepted; accepted and still filtered out. Those are different failures and the platform never merges them.
“Not credited” is a sentence with a date in it
Whether a missing condition is a loss depends entirely on which federal run you checked and whether that payment year has closed. Accepted after the last run isn’t unpaid — it’s unswept. Absent from a closed year’s final run is settled. Alberto never states that something is missing without naming the run and the year’s status.
Rejections clustered by cause, not listed by count
Rejections concentrate: a small number of root causes usually explain most of the volume, and they are frequently a formatting or supplemental-detail problem rather than a clinical one. Grouped by cause, per submitting group and per plan, the fix is an engineering ticket instead of a resubmission campaign.
When a delegated group disputes your numbers
A contracted group hands you a spreadsheet of claims it believes it submitted and asks you to prove what happened. Alberto ingests the file, matches each claim against the warehouse, walks the full submission trail, and returns a per-claim, per-condition disposition: denied, never submitted, not in the warehouse, filtered out of risk adjustment, or still open.
Done by hand, that is days of analyst time per dispute — and the dispute is with a partner you need.
One month of submissions, walked end to end. You’ll know what CMS did with every one.