Assessment guide

What this tool does—and what makes the result useful

Opportunity Navigator begins with public NPI and historical Original Medicare fee-for-service information. It then asks for a small amount of current, aggregate practice information to identify questions worth validating across care programs, payer routes, revenue cycle, team capacity and growth.

1. Establish the scope

Choose one provider, a location, related NPIs or the full organization.

2. Add current facts

Correct what public history cannot show: today’s payers, programs, workload and priorities.

3. Get a next-step plan

See condition-to-program screens, operational actions, evidence gaps and a practice-owned scorecard.

What to share for a more useful assessment

Approximate answers are useful. Unknown answers remain unknown instead of being guessed.

Practice scopeWhich provider, location, selected NPIs or whole organization the numbers cover.

Current payer pictureApproximate payer mix, largest plan products and whether patient cost or authorization creates friction.

Current programsWhat is active, who operates it and an aggregate screened-to-paid funnel if one exists.

Revenue-cycle summariesAggregate denial, A/R, underpayment and payment summaries by payer or claim family.

Team and workflowRole vacancies, overtime, recurring tasks, patient-contact volume and escalation ownership.

Current condition countsAggregate counts or percentages only. Do not provide patient names, records or claim-level files.

Which report files can be checked?

The scorecard can inspect aggregate CSV, TSV, TXT, XLSX, PDF and DOCX files up to 5 MB in your browser. XLSX/CSV are best when you want to work with rows and columns. PDF/DOCX can be checked for readable content, but their values are not automatically treated as verified data.

For older formats, save DOC as DOCX and XLS as XLSX first.

How scorecard comparisons work

The first comparison is always your practice against its own stated goal using the same definition, population and period. Opportunity Navigator does not assign a universal peer score from public claims volume.

Use an external benchmark only when the definition, specialty, size, ownership, population and reporting year are comparable.
For patient experience, use a consistent CAHPS or equivalent instrument and response method.
For clinical quality, use the current CMS Quality Payment Program measure definition and benchmark file when applicable.
For FQHCs and health centers, HRSA Uniform Data System measures may provide the appropriate comparison set.
Detailed medical-practice operating benchmarks are often licensed, such as MGMA DataDive. Do not copy or present them as universal norms without a valid source and license.

What PrimeVital can help validate

Payer and revenue routes

Coverage, patient cost, claims, PMPM/delegation, quality incentives and actual remittance evidence.

Care-program fit

Clinical anchor, compatible additions, enrollment feasibility, patient experience and delivery model.

RCM performance

Eligibility, coding, denials, underpayments, A/R, days-to-cash and recurring-program claim pipelines.

Team capacity

Task-and-time ledger, credential mix, recruitment, shared support and fully managed options.

Growth pilots

A baseline, owner, budget, success measure and vendor comparison for one focused change.

Share Opportunity Navigator

Find the gaps. Verify the opportunity. Build the next move.

Use this QR code in PrimeVital brochures, event handouts and presentations. It opens access.theprimevital.com.

Download the QR code

QR code for PrimeVital Opportunity Navigator

Use aggregate business information only. Do not enter patient names, dates of birth, medical record numbers, clinical notes, claim-level files, contracts, passwords or other protected or restricted information.

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