Executive Overview
Live operational intelligence · Jan 15, 2025
Today's Operations
Refreshed 2 min ago17 claims denied by Aetna in the past 7 days for missing pre-authorization on CPT 90834–90837. This is a 340% increase vs. prior 7-day period. Impacted organizations: Horizon Behavioral Health Partners.
8 claims denied across 3 organizations in past 30 days for frequency limit exceeded. RULE-005 (Medicaid Frequency Check) would have prevented all 8. Zero recovery rate on these claim types.
ENR-003 (MedBridge × Cigna) is blocked due to 2 missing documents: Trading Partner Agreement and Provider Roster. MedBridge reports roster is ready — only TPA signature needed.
TPA-002 (Aetna) and TPA-006 (UHC) are both awaiting payer response past expected SLA. Escalation recommended. UHC direct connect would unlock routing for 18,640 claims/month.
Claim CLM-2025-001815 experienced a hard timeout resulting in unknown payer state. This is the 3rd Claim.MD timeout event in 30 days. Architecture review recommended for payers with native TPA alternatives.
| Claim ID | Organization | Payer | Amount | Status | AI Risk | Route |
|---|---|---|---|---|---|---|
| CLM-2025-001847 | Lakewood Family Medicine Group | Blue Cross Blue Shield | $842.50 | Paid | 12 | Claim.MD |
| CLM-2025-001848 | Horizon Behavioral Health Partners | Aetna | $1,240.00 | Rejected | 87 | Claim.MD |
| CLM-2025-001849 | Summit Outpatient Surgery Center | Medicare | $4,820.00 | Accepted | 8 | Claim.MD |
| CLM-2025-001850 | CardioVascular Associates of Texas | UnitedHealthcare | $3,150.00 | Flagged | 72 | Claim.MD |
| CLM-2025-001851 | MedBridge Billing Solutions | Cigna | $520.00 | Routed to Claim.MD | 24 | Claim.MD |
| CLM-2025-001852 | Lakewood Family Medicine Group | Medicaid | $310.00 | Denied | 91 | Claim.MD |
| CLM-2025-001853 | Horizon Behavioral Health Partners | Humana | $950.00 | Scrubbed | 31 | Claim.MD |
| CLM-2025-001854 | CardioVascular Associates of Texas | Medicare | $2,180.00 | Resubmitted | 18 | Claim.MD |