Prudential Claims Processing

Prudential Insurance Medical Services – Claims & Authentication Platform

Operations Dashboard

Active Claims
312
↑ 9% vs last week
On-Time SLA
97.2%
↑ 1.4%
Avg. Turnaround
3.6h
↓ 42 min
Auth Approval Rate
94.8%
↑ 2.1%
Error / Rework
0.9%
↓ 0.3%
Claim / Auth ID Payer / Client Process Type Priority Status SLA Due Assignee
CLM-88421 National Employer Group Medical Claim Processing High In Progress Today 15:30 Rachel Thompson
AUTH-3391 Midwest Medical Alliance Prior Authorization High Pending Docs Today 17:00 Brian Foster
CLM-88397 Atlantic Benefits Network Procedure Coding Review Medium QC Review Tomorrow 11:00 Lauren Parker
AUTH-3384 National Employer Group Eligibility Verification Medium Approved — Kevin Marshall
CLM-88372 Pacific Health Partners Medical Claim Processing Standard In Progress Wed 14:00 Amanda Clark
AUTH-3379 Midwest Medical Alliance Prior Authorization High Approved — Christopher Walsh
CLM-88355 National Employer Group Medical Claim Processing Medium In Progress Tomorrow 09:30 Rachel Thompson
AUTH-3368 Atlantic Benefits Network Prior Authorization High Pending Docs Today 16:45 Brian Foster
CLM-88341 Pacific Health Partners Procedure Coding Review Standard QC Review Thu 10:00 Lauren Parker
CLM-88328 Midwest Medical Alliance Medical Claim Processing Medium Completed — Kevin Marshall

Submit New Claim / Authorization Batch

📄
Drop claim files or auth packets here
PDF, EDI 837, CMS-1500 images, clinical notes · Max 100 MB

Live Claims & Authorization Board

Intake 6

CLM-88429
Medical claims – BlueCross
High4 min ago
AUTH-3398
Prior auth – UnitedCare
High12 min ago
CLM-88418
Procedure coding batch
Standard38 min ago
AUTH-3402
Eligibility – Aetna
Medium1h ago

Processing 8

CLM-88421
Medical Claim Processing
R. ThompsonDue 15:30
AUTH-3391
Prior Authorization
B. FosterDue 17:00
CLM-88372
Claim processing – Cigna
A. ClarkDue Wed
CLM-88355
Medical claims batch
R. ThompsonDue Tue

QC / Review 4

CLM-88397
Procedure Coding Review
L. ParkerReady
AUTH-3388
Eligibility Verification
K. MarshallReady
CLM-88341
Coding review – Cigna
L. ParkerReady

Completed 22

AUTH-3384
Eligibility Verification
Approved1.9h
AUTH-3379
Prior Authorization
Approved2.4h
CLM-88351
Medical claims batch
Clean3.1h
CLM-88328
Medical Claim Processing
Clean2.8h

CLM-88421 · Medical Claim Processing

National Employer Group · High Priority · SLA Due Today 15:30 · Assignee: Rachel Thompson

Batch Details

Volume
180 claims
Processed
142 / 180
Assignee
Rachel Thompson
Created
Today 08:47
Instructions
Validate CPT/HCPCS against diagnosis. Flag lines > $8,000 or missing pre-auth. Return clean 837-ready data.

Processed Claim Line Items (sample of 32)

Claim # Member ID CPT / Procedure Billed Amt Status
BC-992814MBR-44029127447 – Total knee arthroplasty$18,450Flag – Auth
BC-992815MBR-11839299213 – Office visit$185Clean
BC-992816MBR-55017843239 – EGD with biopsy$1,920Clean
BC-992817MBR-22940193000 – Electrocardiogram$95Coding Q
BC-992818MBR-33120799214 – Established patient visit$245Clean
BC-992819MBR-77401245378 – Colonoscopy$2,150Clean
BC-992820MBR-88219327446 – Arthroplasty, knee$16,800Flag – Auth
BC-992821MBR-10938499203 – New patient visit$210Clean
BC-992822MBR-55672170450 – CT head without contrast$890Clean
BC-992823MBR-22384999232 – Subsequent hospital care$175Clean
BC-992824MBR-66710229881 – Arthroscopy, knee$4,250Coding Q
BC-992825MBR-44190399215 – Office visit, high complexity$310Clean
BC-992826MBR-77829193010 – ECG interpretation$55Clean
BC-992827MBR-33451243235 – Upper GI endoscopy$1,680Clean
BC-992828MBR-99018327130 – Total hip arthroplasty$22,100Flag – Auth
BC-992829MBR-11284799212 – Office visit, straightforward$125Clean
BC-992830MBR-55839271046 – Chest X-ray, 2 views$145Clean
BC-992831MBR-77301999223 – Initial hospital care$290Clean
BC-992832MBR-22648145380 – Colonoscopy with biopsy$2,480Clean
BC-992833MBR-88910220610 – Arthrocentesis$320Clean
BC-992834MBR-44567199204 – New patient, moderate$265Coding Q
BC-992835MBR-33190473721 – MRI lower extremity$1,450Clean
BC-992836MBR-66729399213 – Office visit$185Clean
BC-992837MBR-11847327447 – Total knee arthroplasty$19,200Flag – Auth
BC-992838MBR-55281993000 – Electrocardiogram$95Clean
BC-992839MBR-22938499214 – Established patient$245Clean
BC-992840MBR-77459145378 – Diagnostic colonoscopy$2,050Clean
BC-992841MBR-88310270450 – CT head$890Clean
BC-992842MBR-11029399232 – Subsequent hospital care$175Clean
BC-992843MBR-55918429881 – Knee arthroscopy$4,100Coding Q
BC-992844MBR-44102899215 – High complexity visit$310Clean
BC-992845MBR-77840343239 – EGD with biopsy$1,920Clean

Activity Timeline

  • Today 08:47
    Batch received & auto-routed
  • Today 08:51
    Assigned to Rachel Thompson
  • Today 10:15
    142 of 180 claims processed
  • Today 11:40
    4 claims flagged for missing auth
  • Today 13:05
    3 coding questions raised
  • Now
    In progress – 79% complete

Client Portal · National Employer Group

Secure read-only view for the payer / provider group
This is the secure view shared with payers and provider groups. They can track status, download completed files, and upload missing clinical documents without accessing internal operations.
Open Items
47
Completed (30d)
1,128
On-Time %
97.6%
Avg Turnaround
3.4h
Reference Type Submitted Status ETA / Completed Action
CLM-88421 Medical Claim Processing Today 08:47 In Progress Today 15:30
AUTH-3391 Prior Authorization Today 07:22 Pending Docs Today 17:00
AUTH-3384 Eligibility Verification Yesterday Approved Completed 1.9h
CLM-88351 Medical Claim Processing 2 days ago Completed Completed 3.1h
AUTH-3379 Prior Authorization 3 days ago Approved Completed 2.4h
CLM-88328 Medical Claim Processing 3 days ago Completed Completed 2.8h

Recent Activity

  • AUTH-3384 approved – Eligibility confirmed for member MBR-440291Today 11:12
  • Document request sent for AUTH-3391 – clinical notes requiredToday 10:48
  • CLM-88421 batch 79% complete – 4 high-dollar claims flaggedToday 11:40
  • CLM-88351 completed – 156 clean claims ready for downloadYesterday 16:22
  • AUTH-3379 approved – Prior auth granted for CPT 27447Yesterday 14:05
  • CLM-88328 completed – 142 claims processed, 0 rework2 days ago
  • AUTH-3362 approved – Eligibility verified for MBR-1183922 days ago
  • CLM-88291 completed – Procedure coding review closed3 days ago
  • AUTH-3355 approved – Prior authorization for total hip (27130)3 days ago
  • CLM-88274 completed – 98 claims, all clean4 days ago
  • AUTH-3348 returned – Additional clinical documentation requested4 days ago
  • CLM-88251 completed – Denial reprocessing finished5 days ago
  • AUTH-3339 approved – Eligibility check for new member group5 days ago
  • CLM-88219 completed – 210 claims processed under standard SLA6 days ago
  • AUTH-3331 approved – Prior auth for knee arthroscopy (29881)6 days ago
  • CLM-88187 completed – High-volume professional claims batch1 week ago
  • AUTH-3324 approved – Facility claim authorization cleared1 week ago
  • CLM-88152 completed – Coding review with 3 corrections applied1 week ago
  • AUTH-3317 approved – Eligibility verification completed8 days ago
  • CLM-88108 completed – 175 claims, SLA met at 3.2 hours8 days ago
  • AUTH-3309 approved – Prior authorization for CPT 453789 days ago
  • CLM-88076 completed – Clean claim batch delivered9 days ago
  • AUTH-3301 returned – Missing operative report requested10 days ago
  • CLM-88041 completed – 132 claims processed successfully10 days ago

Performance & Client Reports

Claims Completed (30d)
2,841
Auths Completed (30d)
647
Overall Accuracy
99.1%
Fee / Claim
$150

Volume by Process Type

📊 Claims vs Prior Auth volume

SLA Compliance Trend

📈 On-time % – last 30 days

Payer / Client Performance

Payer / Client Claims (30d) Auths (30d) On-Time % Accuracy Avg Turnaround
National Employer Group 1,124 218 97.6% 99.3% 3.4h
Midwest Medical Alliance 892 195 96.1% 98.9% 3.9h
Atlantic Benefits Network 541 142 94.2% 98.7% 4.6h
Pacific Health Partners 284 92 98.0% 99.4% 3.1h