The standard four-document claim file.

For each standard claim

1. 01
   Patient insurance card

   Used to review plan and coverage information relevant to pathway analysis.

2. 02
   Provider EOB or remittance advice

   Used to understand the original payment, denial, codes, and payer response.

3. 03
   CMS-1500

   Used to organize the submitted professional claim and service information.

4. 04
   Operative notes

   Used to prepare the supporting clinical narrative when applicable.

Collected once at startup

PRP also collects practice and provider profile information before the first matters are submitted. This includes a provider CV and the business, credentialing, and operating information needed to establish the workflow.

Unusual cases

A claim may occasionally require additional documentation. PRP identifies the specific item when the facts, pathway, payer response, or evidence needs call for it.