DEMO MODE
Intake & Pipeline
Prepayment risk classification pipeline.
Stage 1
Ingestion
18,544
ActiveStage 2
Classification
17,431
ProcessingStage 3
Prioritization
8,018
ScoringStage 4
Queue Assignment
6,575
RoutingGREEN · Adjudication41.7%
AMBER · Analyst Review8.3%
RED · Escalation50.0%
Claims Stream
Auto-refresh · 12 of 12 visible
Provider identifiers, case IDs, and exposure amounts are fully synthetic. No real provider data represented.
| Claim # | Type | Provider | Billed | Disposition |
|---|---|---|---|---|
| Last updated 2 min ago · Auto-refresh paused | ||||
| NY-2026-05201 | Other | Maplewood Urgent Care | $2,840 | REDPrepayment Escalation |
| NY-2026-05202 | Other | Crestview DME Services | $12,950 | REDPrepayment Escalation |
| NY-2026-05203 | Other | Clearwater Behavioral Services | $420 | GREENReturn to Adjudication |
| NY-2026-05204 | Other | Lakeview Dental Associates | $6,720 | GREENReturn to Adjudication |
| NY-2026-05205 | Other | Westside Home Health Services | $1,890 | REDPrepayment Escalation |
| NY-2026-05206 | Other | Meridian Diagnostic Imaging | $33,100 | REDPrepayment Escalation |
| NY-2026-05207 | Other | Highland Physical Therapy | $760 | GREENReturn to Adjudication |
| NY-2026-05208 | Other | Mesa Cardiology Associates | $5,120 | GREENReturn to Adjudication |
| NY-2026-05209 | Other | Cornerstone Internal Medicine | $940 | AMBERAnalyst Review |
| NY-2026-05210 | Other | Oakdale Pediatric Group | $15,880 | REDPrepayment Escalation |
| NY-2026-05211 | Other | Summit Orthopedic Group | $2,100 | REDPrepayment Escalation |
| NY-2026-05212 | Other | Harborview Family Medicine | $4,450 | GREENReturn to Adjudication |
NY-2026-05201
RED- Type
- Other
- Provider
- Maplewood Urgent Care
- Billed
- $2,840
NY-2026-05202
RED- Type
- Other
- Provider
- Crestview DME Services
- Billed
- $12,950
NY-2026-05203
GREEN- Type
- Other
- Provider
- Clearwater Behavioral Services
- Billed
- $420
NY-2026-05204
GREEN- Type
- Other
- Provider
- Lakeview Dental Associates
- Billed
- $6,720
NY-2026-05205
RED- Type
- Other
- Provider
- Westside Home Health Services
- Billed
- $1,890
NY-2026-05206
RED- Type
- Other
- Provider
- Meridian Diagnostic Imaging
- Billed
- $33,100
NY-2026-05207
GREEN- Type
- Other
- Provider
- Highland Physical Therapy
- Billed
- $760
NY-2026-05208
GREEN- Type
- Other
- Provider
- Mesa Cardiology Associates
- Billed
- $5,120
NY-2026-05209
AMBER- Type
- Other
- Provider
- Cornerstone Internal Medicine
- Billed
- $940
NY-2026-05210
RED- Type
- Other
- Provider
- Oakdale Pediatric Group
- Billed
- $15,880
NY-2026-05211
RED- Type
- Other
- Provider
- Summit Orthopedic Group
- Billed
- $2,100
NY-2026-05212
GREEN- Type
- Other
- Provider
- Harborview Family Medicine
- Billed
- $4,450
Top Detection Rules Active This Period
Billing Velocity Threshold (>400% baseline)23 flags · 42 CFR 455.23 · 91–97%
Provider Referral Concentration18 flags · CMS-2390-F · 83–90%
Cross-County Route Anomaly14 flags · 42 CFR 455.23 · 78–86%
Same-Day Multi-Provider Billing11 flags · CMS-2390-F · 72–84%
Pharmacy Density Outlier9 flags · 42 CFR 455.23 · 68–79%