Claims Dashboard
Monitor claims processing metrics, trends, and insights
Active members
+8% vs last year
days (service → adjudication)
+12% from last month
18.3% of total claims
Awaiting additional info
$485K outstanding liability
Groups > 75% of deductible
Reimbursement status and processing metrics
Members approaching thresholds and catastrophic risk flags
Approaching attachment point threshold
Oncology, NICU, Transplant, Dialysis
How close each group/contract is to breaching deductible thresholds
⚠️ Near threshold
9 months left
Safe margin
4 months left
⚠️ High utilization
1 month left
Low utilization
7 months left
⚠️ Moderate risk
3 months left
Processing compliance and data completeness
Claim Lag Distribution
Data Quality Metrics
Top diagnosis categories this month
Members over threshold with diagnosis categories and outstanding amounts
| Member ID | Paid Amount | Outstanding | Total Exposure | Plan | Diagnosis Category | Status |
|---|---|---|---|---|---|---|
| HCC-001 | $124,500 | $45,000 | $169,500 | PPO | Oncology | Active |
| HCC-002 | $98,700 | $22,300 | $121,000 | PPO | Cardiac | Active |
| HCC-003 | $87,600 | $65,000 | $152,600 | HMO | Transplant | Pending |
| HCC-004 | $76,300 | $18,700 | $95,000 | HDHP | Neonatal | Active |
| HCC-005 | $65,400 | $12,600 | $78,000 | PPO | Orthopedic | Active |
Automated alerts and recommendations
12 claims detected with similar CPT codes for the same patients within 30 days
22 claims could benefit from more specific ICD-10 codes based on documentation
8 claims flagged for missing documentation or authorization issues