Claim

Claim Task Operation

Title

recent

Notification Center

Data Analytic

Decision Engine

Admin

Back to task pool

Evaluation

Case No. 901730000334059

Last Saved Time 12:12:12

Evaluation
Incident Info
Claimant Info
Loss Party
Payee
Documentation
User/Customer Upload Part
System Generated Part
Add Document Type

You can continue to add files of other types.

Received Full Document Date: 2022.01.01 12:12:12
Last Update Time: 2022.01.01 12:12:12

* Identity Card

Waived

Click or drag the file here to upload

* CLAIM_PAYMENT_NOTICE

Waived

Please input

0 / 100

Others

Click or drag the file here to upload

Withdraw
Submit

AI Claim Assistant

Intelligent Claims Analysis

Document Intelligence

Scan submitted documents for issues

  • Medium Risk0
    Fraud Score0 / 100
    •

    CPT 99285 billed (Level 5 ER) vs documented Level 3 severity

    •

    ICD-10 J18.9 (pneumonia) inconsistent with high-severity ER criteria

    •

    Estimated overcharge: ~$1,800 (99285 vs 99283 differential)

    •

    4 claims filed in past 30 days, averaging $12,400 each

    •

    Specialty baseline: $4,200 per claim (3× above average)

    •

    2 of 6 prior claims previously flagged for SIU review

    •

    Claim filed 21h 43m after patient discharge (May 31, 12:15)

    •

    Industry average: 3–5 business days after discharge

  • Prescription Record authenticity below threshold

Ask about this claim…
Ask AI