DEMO MODE

Review Workbench

Analyst triage and disposition queue.

47 cases in queue9 pending supervisor3 approaching SLA
Human in the Loop Governance

Risk scores and rule firings are decision support signals. Every disposition (Return to Adjudication, Documentation Review, Supervisor Escalation, or Program Integrity Review Package Preparation) is recorded to the audit trail. All actions require documented analyst review. High-severity cases route for supervisor approval before finalization.

Total in Queue
47
Awaiting review
Red Priority
19
P1 · 4h SLA
Yellow Priority
22
P2 · 24h SLA
Pending Supervisor
9
Approval routing
Cleared (24h)
31
Audit logged

9 cases pending supervisor sign-off · 3 approaching 72hr SLA threshold

Domain

Provider identifiers, case IDs, and exposure amounts are fully synthetic. No real provider data represented.

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Items Cleared Today
14
Items Escalated
6
Items Referred
2
Avg Resolution Time
4.2 min

Analyst activity log · Today

Immutable · Audit logged
  1. 10:42 AM
    Analyst D. Park
    CLEARED
    ALT-0023
    Duplicate submission confirmed resolved by provider
  2. 10:38 AM
    Analyst M. Torres
    ESCALATED
    ALT-0019
    Billing velocity exceeds peer baseline by 340%
  3. 10:31 AM
    Supervisor M. Torres
    APPROVED ESCALATION
    ALT-0015
    Supervisor review complete
  4. 10:22 AM
    Analyst D. Park
    PROGRAM INTEGRITY REFERRAL PACKAGE PREPARED
    ALT-0011
    Pattern requires secondary program integrity review
  5. 10:09 AM
    Analyst R. Patel
    PREPAYMENT ESCALATION RECOMMENDED
    ALT-0009
    Prepayment escalation pending documentation review
  6. 9:54 AM
    Analyst M. Torres
    CLEARED
    ALT-0007
    Geographic anomaly explained by approved transport authorization
  7. 9:41 AM
    Supervisor M. Torres
    OVERRIDE. RELEASED
    ALT-0004
    Documented justification. provider produced supporting records
  8. 9:28 AM
    Analyst R. Patel
    ESCALATED
    ALT-0002
    Potential billing-pattern concern pending analyst validation

Operational Friction · Workload Conditions

Active Backlog

247

Cases awaiting analyst pickup

Aging > SLA

38

Cases past first-touch SLA

Awaiting Documentation

61

Provider response pending

Escalated · Supervisor Review

14

Routed for supervisory disposition

Threshold Override Submitted

5

Pending governance committee review

Secondary Review Required

9

Routed to peer analyst

Review Loopbacks (7d)

12

Returned for additional documentation

Disposition Reversals (30d)

3

Supervisor-rescinded determinations

Incomplete Provider Responses

27

Partial documentation submitted

Pending Justification

11

Analyst rationale required before signoff

Duplicate Escalations Detected

4

Cross-pod routing collisions (7d)

Audit Follow-Up Queue

19

Items pending State Audit closure

Governance Exceptions (Open)

7

Policy deviations awaiting committee review

Escalation Bottleneck Index

1.8 ×

Supervisor queue depth vs. 30d baseline

Supervisor Review Delay (Median)

2.4d

Time from escalation to disposition

Workload Surge (24h)

+22%

Intake above rolling 14d mean

Workload Distribution Variance · Analyst Pods

Capacity vs. authorized staffing baseline
Pod ANortheast
Balanced
Active 62 · Aging 784%
Pod BMid-Atlantic
Surge
Active 91 · Aging 14118%
Pod CSoutheast
Balanced
Active 47 · Aging 471%
Pod DMidwest
Elevated
Active 78 · Aging 11104%
Pod EMountain / Plains
Balanced
Active 33 · Aging 258%
Pod FPacific
Constrained
Active 84 · Aging 9126%

Disposition Cycle Variance · By Review Domain

Rolling 14d · vs. quarterly baseline
Disposition cycle variance by review domain
DomainMedian CycleP90 CycleVarianceState
Pharmacy1.6d4.2d+18%Elevated
Transportation2.1d5.8d+34%Delayed
Behavioral Health2.7d7.1d+41%Delayed
Institutional1.2d3.4d+6%Within Target
Provider Network1.4d3.9d+11%Within Target
Cross Domain Patterns3.1d8.4d+52%Delayed

Cycle variance reflects staggered review states, documentation dependencies, supervisor review delays, and governance committee scheduling. Variance is expected in enterprise oversight environments and is monitored, not eliminated, by program integrity leadership.

Recent Workflow Conditions

Rolling 4h window
  1. 11:48·ALT-0214
    Disposition Under Review

    Supervisor L. Hernandez requested additional source documentation before sign-off.

  2. 11:32·ALT-0207
    Awaiting Documentation

    Provider response pending. Second outreach scheduled per provider-engagement protocol.

  3. 11:14·ALT-0198
    Threshold Override Submitted

    Analyst override of pharmacy risk threshold submitted for governance committee review.

  4. 10:57·ALT-0186
    Secondary Analyst Review Required

    Cross domain billing pattern routed to peer analyst per dual control policy.

  5. 10:41·ALT-0172
    Documentation Validation In Progress

    Source records under review by program integrity documentation specialist.

  6. 10:18·ALT-0159
    Audit Escalation Triggered

    Case routed to State Audit oversight per repeat-finding escalation rule.

  7. 09:52·ALT-0141
    Governance Review Pending

    Disposition held for monthly governance review · scheduled committee cycle.

  8. 09:33·ALT-0128
    Escalated · Pending Supervisor Review

    P1 disposition routed for supervisory approval before payment-disposition finalization.

  9. 09:11·ALT-0117
    Duplicate Escalation Detected

    Case previously routed by Pod-B identified during Pod-D intake; consolidated under originating analyst.

  10. 08:54·ALT-0103
    Pending Justification

    Analyst rationale required before threshold-override request advances to governance committee.

  11. 08:37·ALT-0091
    Audit Follow-Up Open

    State Audit requested supplemental disposition notes prior to finding closure.

  12. 08:12·ALT-0078
    Governance Exception Filed

    Policy deviation logged for pharmacy-domain threshold; queued for monthly governance committee review.

Workflow states reflect realistic operational conditions in state program integrity environments, including review loopbacks, documentation dependencies, supervisor intervention, and audit-oversight escalation. All payment actions require documented analyst review and supervisory disposition where required.