Case Lifecycle State Distribution

Open and closed cases across eight workflow states. Advancement requires documented analyst or supervisor action.

Stage 01
INTAKE
18
Stage 02
SCORED
31
Stage 03
QUEUED
42
Stage 04
ASSIGNED
38
Stage 05
IN REVIEW
29
Stage 06
PENDING SUPERVISOR
12
Stage 07
DISPOSITION RECORDED
56
Stage 08
CLOSED
31

Operational Friction · Workload Conditions

247

38

61

14

5

9

12

3

27

11

4

19

7

1.8 ×

2.4d

+22%

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
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.

  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.

Review Accountability Indicators

34

11

3

247

14

23

31

Immutable Event Log

Append-only · WORM
0 events

Audit entries are write-once, retained per state record-retention policy, and structured for export to authorized oversight and internal audit functions where applicable.

Governance Posture

Human in the Loop

No prepayment escalation, clearance, or referral without named analyst determination in this log.

Attribution & Accountability

Every transition bound to authenticated user. Overrides require justification and supervisor approval.

Explainability

Rule firings include identifier, threshold, and input features visible to analyst and supervisor.

Append-Only Storage

Records immutable. Corrections appear as new entries referencing the original.

Threshold Change Control

Threshold adjustments logged with proposer, approver, and effective date.

Independent Reviewability

Exportable for internal audit and oversight review without vendor assistance.