Claims Management
Real-time MonitoringMonitor and investigate potential fraud, waste, and abuse cases
Total Claims:1,842
Under Investigation:326
High Risk:42
| Claim ID | Provider | Patient | Type | Score | Amount | Status | Flagged Rule | Actions |
|---|---|---|---|---|---|---|---|---|
| CLM-631 | King Faisal Specialist | Ahmed Al-Ghamdi | Cardiac Bypass Surgery | 94% | $87,500 | investigation | CCHI Tariff Violation - Code SA-1124 | |
| CLM-632 | King Abdulaziz MC | Fatima Al-Harbi | MRI Brain (With Contrast) | 88% | $4,200 | pending | Unauthorized Repeat Imaging | |
| CLM-633 | Dr. Sulaiman Al Habib | Khalid Al-Otaibi | Emergency Laparoscopy | 76% | $22,500 | approved | Upcoding - Routine to Emergency | |
| CLM-634 | King Khalid University | Layla Al-Qahtani | Diabetic Retinopathy Screening | 45% | $850 | rejected | Preventive Service Billed as Diagnostic | |
| CLM-635 | King Abdullah | Omar Al-Shehri | Physical Therapy | 68% | $2,150 | investigation | Unbundling - SA-PT-300 Series | |
| CLM-636 | Al-Noor Specialist | Aisha Al-Zahrani | High-Risk Pregnancy Package | 81% | $18,700 | pending | Ineligible for SA-MCH-200 | |
| CLM-637 | King Salman | Ali Omar | Exe. Health Screening Package | 65% | $18,500 | investigation | Unauthorized Royal Protocol Activation | |
| CLM-638 | Al-Iman General | Mariam Ali | Diabetes Management Package | 83% | $6,700 | rejected | Violation of MOH Chronic Care | |
| CLM-639 | Dr. Soliman Fakeeh | Ananya Patel | Pediatric Asthma Admission | 91% | $12,800 | investigation | Policy Lapse - CCHI Dependent Coverage | |
| CLM-640 | Al-Haram Hospital | Yusuf Al-Maliki | Acute Gastroenteritis | 72% | $3,200 | pending | Non-Citizen Without Mandatory Insurance |
Showing 1-10 of 1,842 claims