Workflows
24 decisions · 23 governed
3
MS
My view
All Health Plan
Assigned to you · updated 3 min ago
Active (4)
Completed (22)
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New Workflow
Status: All
Type: All
Complexity: All
Date range: Last 7 days
In Progress
Complex Claim Adjudication — Member M-8832, Cardiac Rehab Extension
Claim Adjudication
High Complexity
Started 9 Aug, 09:15
Step 4 of 6 · Benefit verification & policy cross-reference
MS
Maria Santos
3 of 4 checkpoints
Open →
In Progress
Prior Authorization — Member M-7745, CPAP Replacement
Prior Auth
Low Complexity
Started 8 Aug, 11:00
Benefit and equipment-age verification
MS
Maria Santos
2 of 2
Open →
Paused
Prior Authorization — Member M-6614, CAR-T Therapy
Prior Auth
High Complexity
Started 8 Aug · Referred to medical director
Awaiting clinical review (Dr. Patel)
MS
Maria Santos
1 of 1
Open →
Not Started
Claim Review — Member M-3291, Out-of-Network Emergency
Claim Review
Medium Complexity
Due 12 Aug 2026
Queued
MS
Maria Santos
—
Open →