Prior-Auth, Level-of-Care & Denials Prevention
Concurrent prior-auth orchestration, observation-vs-inpatient status optimization, and predictive pre-bill denials prevention — wired to a throughput-to-margin control tower.
Prior-Auth Worklist
| Patient | Payer | Auth | SLA | Rev at risk | |
|---|---|---|---|---|---|
Lucia Santos MRN-531403 · Med-Surg A | UnitedHealth Navigate | Pending | +77h 22m over | $5.2k | |
Diego Nguyen MRN-236115 · Step-Down | Aetna Select | Pending | +76h 5m over | $2.8k | |
Diego Patel MRN-251052 · Step-Down | UnitedHealth Navigate | Pending | +74h 23m over | $8.2k | |
Kofi Ortiz MRN-468273 · Flex / Overflow | Cigna LocalPlus | At risk | +72h 7m over | $7.1k | |
Ruth Haddad MRN-106003 · Med-Surg A | Medicaid Managed Care | At risk | +71h 57m over | $4.2k | |
Chloe Flores MRN-348345 · Telemetry | Cigna LocalPlus | At risk | +71h 50m over | $12k | |
Henry Ito MRN-869942 · Med-Surg B | Medicaid Fee-for-Service | Pending | +70h 35m over | $4.5k | |
Diego Abara MRN-643137 · Med-Surg B | Aetna Select | Pending | +68h 25m over | $1.8k | |
Nadia Adeyemi MRN-579090 · Med-Surg B | BlueCross PPO | At risk | +66h 13m over | $4.9k | |
Patricia Bauer MRN-485446 · Med-Surg A | Aetna Open Access | At risk | +63h 52m over | $4.0k | |
Aisha Dubois MRN-276073 · Med-Surg B | Cigna Open Access Plus | At risk | +63h 24m over | $3.3k | |
Priya Bauer MRN-157815 · Med-Surg B | BlueCross PPO | Pending | +60h 40m over | $4.6k | |
Priya Abara MRN-659742 · ICU | Medicare Advantage HMO | At risk | +59h 57m over | $19k | |
Aisha Flores MRN-272451 · Telemetry | Medicare Advantage HMO | Pending | +59h 36m over | $3.7k | |
Priya Castillo MRN-790062 · Med-Surg B | Aetna Select | At risk | +56h 36m over | $4.7k | |
Ethan Adeyemi MRN-667243 · Med-Surg A | UnitedHealth Navigate | Pending | +56h 8m over | $3.4k | |
Linda Nguyen MRN-764666 · Med-Surg A | UnitedHealth Choice Plus | Pending | +55h 23m over | $6.8k | |
Mia Sato MRN-910420 · Telemetry | BlueCross HMO | At risk | +52h 28m over | $5.0k | |
Elena Abara MRN-367855 · Med-Surg A | UnitedHealth Navigate | At risk | +51h 34m over | $4.5k | |
Yuki Abara MRN-656248 · ICU | UnitedHealth Choice Plus | Pending | +49h 3m over | $6.3k | |
Omar Mbeki MRN-163451 · Med-Surg B | Medicaid Managed Care | Pending | +47h 9m over | $2.6k | |
Sofia Petrov MRN-342878 · Telemetry | BlueCross HMO | At risk | +46h 55m over | $5.4k | |
David Cohen MRN-139427 · Telemetry | Cigna Open Access Plus | Pending | +46h 21m over | $2.5k | |
Grace Salas MRN-287157 · Med-Surg B | UnitedHealth Choice Plus | Pending | +45h 30m over | $4.5k | |
John Yamamoto MRN-487474 · Step-Down | Medicare Traditional A/B | Pending | +44h 39m over | $4.6k | |
Ava Ito MRN-520194 · Med-Surg A | Medicaid Managed Care | Pending | +44h 19m over | $2.8k | |
Ethan Larsson MRN-686545 · ICU | Cigna LocalPlus | Pending | +42h 20m over | $5.9k | |
Yuki Okafor MRN-694266 · Step-Down | Medicaid Managed Care | At risk | +42h 15m over | $7.6k | |
Isaac Romano MRN-352184 · Med-Surg B | Cigna Open Access Plus | At risk | +41h 48m over | $6.4k | |
Mia Patel MRN-350233 · Telemetry | Medicare Advantage PPO | At risk | +39h 40m over | $6.5k | |
John Khan MRN-231459 · Step-Down | Medicaid Managed Care | At risk | +39h 31m over | $12k | |
Maria Romano MRN-406846 · Flex / Overflow | UnitedHealth Navigate | At risk | +38h 1m over | $2.7k | |
Robert Fischer MRN-463357 · Med-Surg A | Medicaid Managed Care | Pending | +37h 24m over | $4.2k | |
Mateo Salas MRN-202641 · Telemetry | UnitedHealth Navigate | Pending | +36h 37m over | $8.9k | |
Pavel Salas MRN-610120 · Med-Surg A | Medicaid Managed Care | At risk | +36h 29m over | $5.9k | |
Robert Adeyemi MRN-768672 · ICU | Medicaid Managed Care | Pending | +36h 3m over | $6.2k | |
Kofi Reyes MRN-182650 · Telemetry | Medicare Advantage HMO | Pending | +35h 43m over | $3.7k | |
James Kim MRN-788478 · Telemetry | Medicare Traditional A/B | At risk | +34h 3m over | $7.0k | |
Carlos Petrov MRN-397672 · Med-Surg B | Medicare Advantage HMO | Pending | +33h 9m over | $5.2k | |
Maria Novak MRN-649501 · Med-Surg A | BlueCross Federal | Pending | +32h 5m over | $4.4k | |
Carlos Mercer MRN-175749 · Step-Down | Aetna Open Access | At risk | +28h 53m over | $7.0k | |
Ethan Fischer MRN-106446 · Med-Surg B | Aetna Select | Pending | +25h 20m over | $5.4k | |
Ruth Adeyemi MRN-987490 · Telemetry | BlueCross Federal | At risk | +23h 23m over | $8.8k | |
Theo Cohen MRN-578577 · Med-Surg B | Medicaid Fee-for-Service | At risk | +22h 23m over | $4.1k | |
Kofi Yamamoto MRN-542610 · Telemetry | Cigna Open Access Plus | At risk | +20h 23m over | $7.6k | |
Priya Reyes MRN-667992 · Telemetry | BlueCross Federal | Pending | +18h 19m over | $4.0k | |
Zara Cohen MRN-452855 · Telemetry | Medicaid Managed Care | Pending | +17h 43m over | $2.1k | |
James Cohen MRN-426492 · PACU | Cigna LocalPlus | Pending | +17h 1m over | $1.1k | |
Sofia Khan MRN-110990 · Telemetry | Aetna Open Access | Pending | +15h 38m over | $6.5k | |
Omar Walsh MRN-803038 · ICU | UnitedHealth Choice Plus | Pending | +15h 23m over | $14k | |
Nadia Haddad MRN-332803 · PACU | Aetna Select | At risk | +14h 55m over | $2.1k | |
Pavel Mercer MRN-531840 · Flex / Overflow | BlueCross PPO | Pending | +13h 58m over | $7.4k | |
Linda Patel MRN-721166 · Med-Surg A | Medicare Traditional A/B | Pending | +13h 22m over | $4.1k | |
Chloe Abara MRN-985714 · Med-Surg A | Medicare Advantage HMO | At risk | +12h 52m over | $4.1k | |
John Abara MRN-888561 · Med-Surg B | Aetna Select | Pending | +12h 50m over | $2.0k | |
David Petrov MRN-964469 · Med-Surg B | Cigna Open Access Plus | At risk | +12h 12m over | $4.1k | |
Lucia Flores MRN-218083 · ICU | Medicare Traditional A/B | Pending | +10h 35m over | $15k | |
Diego Cohen MRN-528139 · Flex / Overflow | Medicare Traditional A/B | Pending | +9h 15m over | $2.1k | |
Jamal Bauer MRN-420589 · Telemetry | Medicaid Managed Care | Pending | +8h 57m over | $11k | |
Aisha Boyd MRN-842277 · ICU | Cigna Open Access Plus | At risk | +6h 52m over | $18k | |
Wei Santos MRN-697415 · Step-Down | Medicaid Fee-for-Service | Pending | +6h 7m over | $6.1k | |
Pavel Sato MRN-160357 · Step-Down | Cigna Open Access Plus | Pending | +5h 23m over | $12k | |
Ruth Adeyemi MRN-593138 · ICU | BlueCross Federal | Pending | +4h 33m over | $5.2k | |
Imani Novak MRN-172326 · Med-Surg B | Cigna Open Access Plus | Pending | +4h 18m over | $2.3k | |
Sofia Nguyen MRN-915638 · PACU | BlueCross PPO | Pending | +3h 31m over | $2.2k | |
Imani Yamamoto MRN-786198 · Step-Down | Medicare Advantage HMO | Pending | +2h 11m over | $4.9k | |
Priya Walsh MRN-657757 · ICU | BlueCross HMO | At risk | +1h 3m over | $14k | |
Isaac Ito MRN-149272 · Med-Surg A | UnitedHealth Choice Plus | At risk | +47m over | $7.5k | |
Sofia Ito MRN-909561 · ICU | Cigna Open Access Plus | Pending | 1h 12m | $7.3k | |
Mia Nguyen MRN-915773 · Med-Surg A | Medicare Advantage HMO | At risk | 5h 57m | $8.0k | |
Pavel Okafor MRN-509758 · Emergency Dept | UnitedHealth Choice Plus | Pending | 11h | $1.7k | |
Carlos Castillo MRN-889877 · Telemetry | UnitedHealth Choice Plus | Pending | 16h 53m | $3.2k | |
Imani Patel MRN-492231 · Emergency Dept | BlueCross Federal | At risk | 19h 54m | $6.8k |
Throughput-to-Margin Tower
83% occAt 83% occupancy, every ED boarder-hour costs ~$220 in deferred margin. Clearing throughput pressure converts directly into avoided denial exposure.
Level-of-Care Optimization
36 mismatchesMRN-659742 · ICU · Medicare
Stable vitals, no inpatient-only procedure on chart
MRN-218083 · ICU · Medicare
Improving deterioration score; inpatient criteria not met
MRN-160357 · Step-Down · Cigna
Diagnostic-only stay; payer favors observation status
MRN-231459 · Step-Down · Medicaid
Stable vitals, no inpatient-only procedure on chart
MRN-420589 · Telemetry · Medicaid
Diagnostic-only stay; payer favors observation status
MRN-251052 · Step-Down · UnitedHealth
Improving deterioration score; inpatient criteria not met
MRN-542610 · Telemetry · Cigna
Stable vitals, no inpatient-only procedure on chart
MRN-573136 · Telemetry · Medicare
Improving deterioration score; inpatient criteria not met
MRN-175749 · Step-Down · Aetna
Stable vitals, no inpatient-only procedure on chart
MRN-764666 · Med-Surg A · UnitedHealth
Diagnostic-only stay; payer favors observation status
MRN-350233 · Telemetry · Medicare
Stable vitals, no inpatient-only procedure on chart
MRN-110990 · Telemetry · Aetna
LOS trending < 2 midnights; observation supports medical necessity
MRN-656248 · ICU · UnitedHealth
Diagnostic-only stay; payer favors observation status
MRN-898468 · ICU · UnitedHealth
Diagnostic-only stay; payer favors observation status
MRN-397672 · Med-Surg B · Medicare
Improving deterioration score; inpatient criteria not met
MRN-531403 · Med-Surg A · UnitedHealth
LOS trending < 2 midnights; observation supports medical necessity
MRN-238108 · Telemetry · Aetna
Improving deterioration score; inpatient criteria not met
MRN-287157 · Med-Surg B · UnitedHealth
LOS trending < 2 midnights; observation supports medical necessity
MRN-367855 · Med-Surg A · UnitedHealth
Improving deterioration score; inpatient criteria not met
MRN-106003 · Med-Surg A · Medicaid
Diagnostic-only stay; payer favors observation status
MRN-721166 · Med-Surg A · Medicare
LOS trending < 2 midnights; observation supports medical necessity
MRN-667992 · Telemetry · BlueCross
LOS trending < 2 midnights; observation supports medical necessity
MRN-311864 · Step-Down · BlueCross
LOS trending < 2 midnights; observation supports medical necessity
MRN-192879 · PACU · Medicare
Improving deterioration score; inpatient criteria not met
MRN-182993 · Step-Down · Medicare
Diagnostic-only stay; payer favors observation status
MRN-163451 · Med-Surg B · Medicaid
Stable vitals, no inpatient-only procedure on chart
MRN-915638 · PACU · BlueCross
Stable vitals, no inpatient-only procedure on chart
MRN-414305 · PACU · Medicaid
LOS trending < 2 midnights; observation supports medical necessity
MRN-332803 · PACU · Aetna
Improving deterioration score; inpatient criteria not met
MRN-452855 · Telemetry · Medicaid
LOS trending < 2 midnights; observation supports medical necessity
MRN-109079 · Med-Surg B · UnitedHealth
Improving deterioration score; inpatient criteria not met
MRN-840836 · Med-Surg B · Aetna
Improving deterioration score; inpatient criteria not met
MRN-223664 · Med-Surg A · Medicaid
Improving deterioration score; inpatient criteria not met
MRN-361471 · Med-Surg B · UnitedHealth
LOS trending < 2 midnights; observation supports medical necessity
MRN-152096 · Telemetry · UnitedHealth
Diagnostic-only stay; payer favors observation status
MRN-878281 · Med-Surg A · Medicaid
Stable vitals, no inpatient-only procedure on chart
Denials Risk
8 to workMRN-192879 · Medicare
Top driver: Auth obtained after admit (47%)
MRN-573136 · Medicare
Top driver: Diagnosis not on payer list (46%)
MRN-472634 · UnitedHealth
Top driver: Missing clinical documentation (46%)
MRN-785478 · Medicare
Top driver: Two-midnight rule mismatch (51%)
MRN-542610 · Cigna
Top driver: Out-of-network specialist (51%)
MRN-744175 · Cigna
Top driver: Late concurrent review (49%)
MRN-915773 · Medicare
Top driver: Coding / DRG ambiguity (47%)
MRN-332803 · Aetna
Top driver: Missing clinical documentation (53%)