Acuity — From Audit to Governance Instrument
Acuity
Intro
Sedgwick Canada  ·  Claims Performance Intelligence

Acuity

How a claims audit stops being a scorecard
and becomes a governance instrument.
A three-part briefing
Press → or play to begin
The Acuity Cycle · at a glance

One cycle, end to end — every handoff gated, every outcome reported.

01
Audit
Audit Tool
✓gate→
02
Aggregate & report
Aggregator
✓gate→
03
Cycle-open gate
Verify prior cycle
✓gate→
04
Govern & sign off
Register
✓gate→
05
Committee & client
Route findings
→
06
Carry-forward
Into next cycle
Outcome report — every cycle reports out
Program movement Commitment effectiveness Rationalized ROI Accountability by lane Signed & locked
↻ Carry-forward — open items and commitments roll into the next cycle’s gate, so nothing is dropped between cycles.
The Market Gap — 01

The traditional claims audit answers the wrong question.

96%
File "compliant"
→
…but why did it slip?
Compliance scoring tells you what broke on the file. It never tells you why — or whose job it was to prevent it.
The Market Gap — 02

So three things quietly fail.

01
Symptom, not cause
A score rates the file, not the reason it slipped. The same finding returns next quarter — because nothing diagnosed the cause.
02
One lane of blame
Every miss lands on the adjuster — even when the real cause was a client delay or a system the adjuster doesn’t control.
03
Findings die in a binder
No one proves the fix worked. There is no record that anything improved. Nothing compounds, cycle to cycle.
A report that scores the past — and changes nothing about the future.
The Acuity System — 03

Acuity diagnoses the cause, routes the accountability, and proves the outcome.

◆
Diagnose root cause
7-code taxonomy
⇄
Route to the right lane
Adjuster · Client · Sedgwick
✓
Decide & sign off
Accept · Defer · Decline
⇅
Verify effectiveness
Did it move the outcome?
▲
Intelligence compounds
Cycle over cycle
The same five steps, every cycle — turning an audit into a closed loop.
The Acuity System — 04

Every finding is routed to the lane that actually owns it.

FINDING — late medical authorization

Adjuster

Skill · Knowledge
A capability gap becomes targeted coaching — not a blanket reprimand.

Client

Client-driven delay
A client-side cause becomes a formal call to action the client owns and signs.

Sedgwick

Process · Capacity · System · Leadership
A structural cause becomes an operational commitment at the right level.
Accountability goes where the cause lives — defensible, evidenced, and no longer adjuster-by-default.
Acuity as a Governance Tool — 05

Across cycles, Acuity becomes the program’s governance operating system.

Audit cycle
Decisions registered
Standards updated
Signed off & locked
Gate verifies last cycle
Program score
2.73 → 3.06
and rising, cycle over cycle
The instruments
Decision RegisterEvery accept / defer / decline, recorded for the life of the program.
Effectiveness LedgerProof each commitment moved the outcome it promised.
Cycle-Open GateNo cycle closes until the last one’s commitments are verified.
A self-auditing record that gets smarter — and harder to dispute — every cycle.
Effort & Return — 06

A traditional audit ends at the report. Acuity keeps going — and that’s where the return lives.

Traditional Auditthe entire process
Time invested
≈ 1 hour / file
Data review ~35m · adjuster feedback ~15m · report ~10m — then it ends.
Process ROI
None → slight
Findings seldom convert into measured savings, so there is little to quantify.
Acuity System Auditaudit + analysis + governance
Time invested
≈ 1 hr audit + ~45 min analysis / file
…then a governance cycle that runs for weeks: routing, sign-off, commitment tracking and verification.
Process ROI
Significant & measurable
Tracked commitments and verified outcomes create a real margin to calculate or estimate.
Time and ROI figures are illustrative estimates — set them against your own account data.
The Shift
From compliance scoring
to governed, compounding
performance intelligence.
Acuity
Sedgwick Canada · Claims Performance Intelligence
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