Build a SIPOC for a claims edit workflow

A specialty claims edit catches 312 claims in a week, triple the expected volume, and the team needs to identify whether the issue is rule, data, or workflow. SIPOC: clarify suppliers, inputs, process, outputs, and customers before detailed redesign. The common trap is tuning the edit threshold before understanding which input or customer requirement is being missed. Suppliers Providers supply claim data; configuration supplies edit logic; provider data supplies NPI and taxonomy; policy supplies service criteria. Multiple suppliers means the edit can fail before the claim analyst sees it. Inputs Required inputs: service code, diagnosis, referring-provider NPI, member eligibility, network…

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