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Pre-Auth PendingToday
1pending12 due in <4h
Awaiting hospital / TPA response
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Queries to RespondUrgent
2pendingSLA in 6h
Open queries with hospitals / TPA
Respond now
Documents MissingToday
1pendingOCR pending
Submitted but waiting on KYC / bills
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TAT Breach RiskCritical
1pendingBreaching today
Already breached SLA
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Payments PendingThis week
2pendingTrack payouts
Awaiting payout from insurer
Reconcile
Claim KPIs
Financial summary
Claim ageing
Distribution by days since submission
Claim pipeline
Live claim flow across processing stages
Total in pipeline: 12Settled: 1
TAT alerts
Claims approaching or breaching SLA
Recent claim activity
Latest claim updates across all stages
| Claim ID | Patient | Hospital | Stage | Amount | Status |
|---|---|---|---|---|---|
| CLM-2451 | Ananya Rao | Apollo Hospitals, Hyderabad | Approved | ₹1,84,500 | On track |
| CLM-2450 | Rohit Verma | Fortis Memorial, Gurugram | Query | ₹96,300 | At risk |
| CLM-2449 | Meera Iyer | Manipal Hospital, Bangalore | Payment | ₹2,45,000 | On track |
| CLM-2448 | Kabir Singh | Max Super Speciality, Delhi | TPA Ack | ₹3,12,800 | On track |
| CLM-2447 | Diya Sharma | Narayana Health, Chennai | Submitted | ₹58,900 | On track |
| CLM-2446 | Arjun Nair | AIIMS Panel, New Delhi | Pre Auth | ₹1,42,000 | On track |
| CLM-2445 | Sneha Patel | Kokilaben Hospital, Mumbai | Rejected | ₹4,78,200 | Rejected |
Hospital performance
Top hospitals by claim volume
| Hospital | Claims | Approval rate | Avg. TAT | Query rate |
|---|---|---|---|---|
| Apollo Hospitals Hyderabad | 2 | 92.4% | 5.8d | 6.4% |
| AIIMS Panel New Delhi | 2 | 88.1% | 7.2d | 9.1% |
| Fortis Memorial Gurugram | 2 | 90.6% | 6.4d | 7.0% |
| Kokilaben Hospital Mumbai | 1 | 86.2% | 8.1d | 11.2% |
| Manipal Hospital Bangalore | 2 | 91.0% | 6.0d | 5.8% |
| Max Super Speciality Delhi | 1 | 89.4% | 6.7d | 8.2% |
TPA / insurer mix
Payer distribution and performance
| Payer | Claims | Approval | Deduction | Avg. TAT |
|---|---|---|---|---|
| MediAssist | 3 | 91.2% | 3.4% | 5.9d |
| Star Health | 3 | 88.4% | 4.1% | 6.4d |
| Health India | 2 | 86.7% | 4.8% | 7.1d |
| Paramount | 2 | 84.2% | 5.2% | 7.8d |
| Ayushman | 1 | 82.0% | 6.4% | 9.2d |
| CGHS | 1 | 85.5% | 4.7% | 8.4d |
Processor performance
Claim handler productivity and quality
| Processor | Claims | Avg. TAT | Approval | Queries |
|---|---|---|---|---|
| PSPriya Sharma | 184 | 5.2d | 93.1% | 12 |
| RMRahul Menon | 162 | 6.0d | 90.4% | 18 |
| AIAnita Iyer | 148 | 5.8d | 91.8% | 14 |
| VJVikram Joshi | 132 | 7.1d | 87.6% | 22 |
| SKSneha Kapoor | 118 | 6.4d | 89.2% | 16 |