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Claims & authorisation · Workflow example

AIA Global Processing Claims

An illustrative view of claims intake, administrative processing, quality review and reporting.

Explore the workflow example
Workflow overviewIllustrative example
  1. IntakeClaim and authorisation information
  2. ProcessingAdministrative handling and verification
  3. QC / ReviewReview of exceptions and supporting details
  4. CompletedRecorded outcomes and reporting

Sample records and process information. No live submissions are processed here.

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 AIA Hong Kong Corporate Medical Claim Processing High In Progress Today 15:30 Olivia Bennett
AUTH-3391 AIA Singapore Group Prior Authorization High Pending Docs Today 17:00 Ethan Brooks
CLM-88397 AIA Thailand Benefits Procedure Coding Review Medium QC Review Tomorrow 11:00 Sophia Ellis
AUTH-3384 AIA Hong Kong Corporate Eligibility Verification Medium Approved — Noah Grant
CLM-88372 AIA Malaysia Partners Medical Claim Processing Standard In Progress Wed 14:00 Ava Morgan
AUTH-3379 AIA Singapore Group Prior Authorization High Approved — Liam Foster
CLM-88355 AIA Hong Kong Corporate Medical Claim Processing Medium In Progress Tomorrow 09:30 Olivia Bennett
AUTH-3368 AIA Thailand Benefits Prior Authorization High Pending Docs Today 16:45 Ethan Brooks
CLM-88341 AIA Malaysia Partners Procedure Coding Review Standard QC Review Thu 10:00 Sophia Ellis
CLM-88328 AIA Singapore Group Medical Claim Processing Medium Completed — Noah Grant

Example Claim / Authorization Intake

Payer / Client

  • AIA Hong Kong Corporate
  • AIA Singapore Group
  • AIA Thailand Benefits
  • AIA Malaysia Partners

Process Type

  • Medical Claim Processing
  • Prior Authorization
  • Eligibility Verification
  • Procedure Coding Review
  • Claim Denial Reprocessing

Priority / SLA

  • High – 4 hour SLA
  • Standard – 24 hour SLA
  • Routine – 72 hour SLA

Expected Volume

180 claims

Special Instructions

Process professional and facility claims. Validate CPT/HCPCS against diagnosis codes. Flag any claim line > $8,000 or missing pre-auth for secondary review. Return clean 837-ready data.

Source File Examples

Example source material: claim files or authorisation packets.

Example file types: PDF, EDI 837, CMS-1500 images and clinical notes; original mock-up limit: 100 MB.

Example Claims & Authorization Board

Intake 6

CLM-88429
Medical claims – BlueCross
High 4 min ago
AUTH-3398
Prior auth – UnitedCare
High 12 min ago
CLM-88418
Procedure coding batch
Standard 38 min ago
AUTH-3402
Eligibility – Aetna
Medium 1h ago

Processing 8

CLM-88421
Medical Claim Processing
O. Bennett Due 15:30
AUTH-3391
Prior Authorization
E. Brooks Due 17:00
CLM-88372
Claim processing – Cigna
A. Morgan Due Wed
CLM-88355
Medical claims batch
O. Bennett Due Tue

QC / Review 4

CLM-88397
Procedure Coding Review
S. Ellis Ready
AUTH-3388
Eligibility Verification
N. Grant Ready
CLM-88341
Coding review – Cigna
S. Ellis Ready

Completed 22

AUTH-3384
Eligibility Verification
Approved 1.9h
AUTH-3379
Prior Authorization
Approved 2.4h
CLM-88351
Medical claims batch
Clean 3.1h
CLM-88328
Medical Claim Processing
Clean 2.8h

CLM-88421 · Medical Claim Processing

AIA Hong Kong Corporate · High Priority · SLA Due Today 15:30 · Assignee: Olivia Bennett

Batch Details

Volume
180 claims

Processed
142 / 180

Assignee
Olivia Bennett

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-992814 MBR-440291 27447 – Total knee arthroplasty $18,450 Flag – Auth
BC-992815 MBR-118392 99213 – Office visit $185 Clean
BC-992816 MBR-550178 43239 – EGD with biopsy $1,920 Clean
BC-992817 MBR-229401 93000 – Electrocardiogram $95 Coding Q
BC-992818 MBR-331207 99214 – Established patient visit $245 Clean
BC-992819 MBR-774012 45378 – Colonoscopy $2,150 Clean
BC-992820 MBR-882193 27446 – Arthroplasty, knee $16,800 Flag – Auth
BC-992821 MBR-109384 99203 – New patient visit $210 Clean
BC-992822 MBR-556721 70450 – CT head without contrast $890 Clean
BC-992823 MBR-223849 99232 – Subsequent hospital care $175 Clean
BC-992824 MBR-667102 29881 – Arthroscopy, knee $4,250 Coding Q
BC-992825 MBR-441903 99215 – Office visit, high complexity $310 Clean
BC-992826 MBR-778291 93010 – ECG interpretation $55 Clean
BC-992827 MBR-334512 43235 – Upper GI endoscopy $1,680 Clean
BC-992828 MBR-990183 27130 – Total hip arthroplasty $22,100 Flag – Auth
BC-992829 MBR-112847 99212 – Office visit, straightforward $125 Clean
BC-992830 MBR-558392 71046 – Chest X-ray, 2 views $145 Clean
BC-992831 MBR-773019 99223 – Initial hospital care $290 Clean
BC-992832 MBR-226481 45380 – Colonoscopy with biopsy $2,480 Clean
BC-992833 MBR-889102 20610 – Arthrocentesis $320 Clean
BC-992834 MBR-445671 99204 – New patient, moderate $265 Coding Q
BC-992835 MBR-331904 73721 – MRI lower extremity $1,450 Clean
BC-992836 MBR-667293 99213 – Office visit $185 Clean
BC-992837 MBR-118473 27447 – Total knee arthroplasty $19,200 Flag – Auth
BC-992838 MBR-552819 93000 – Electrocardiogram $95 Clean
BC-992839 MBR-229384 99214 – Established patient $245 Clean
BC-992840 MBR-774591 45378 – Diagnostic colonoscopy $2,050 Clean
BC-992841 MBR-883102 70450 – CT head $890 Clean
BC-992842 MBR-110293 99232 – Subsequent hospital care $175 Clean
BC-992843 MBR-559184 29881 – Knee arthroscopy $4,100 Coding Q
BC-992844 MBR-441028 99215 – High complexity visit $310 Clean
BC-992845 MBR-778403 43239 – EGD with biopsy $1,920 Clean

Activity Timeline

  • Today 08:47
    Batch received & auto-routed
  • Today 08:51
    Assigned to Olivia Bennett
  • 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 · AIA Hong Kong Corporate

Secure read-only view for corporate clients and partners worldwide

This is the secure view shared with AIA corporate clients and partners worldwide. 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
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-440291 Today 11:12
  • Document request sent for AUTH-3391 – clinical notes required Today 10:48
  • CLM-88421 batch 79% complete – 4 high-dollar claims flagged Today 11:40
  • CLM-88351 completed – 156 clean claims ready for download Yesterday 16:22
  • AUTH-3379 approved – Prior auth granted for CPT 27447 Yesterday 14:05
  • CLM-88328 completed – 142 claims processed, 0 rework 2 days ago
  • AUTH-3362 approved – Eligibility verified for MBR-118392 2 days ago
  • CLM-88291 completed – Procedure coding review closed 3 days ago
  • AUTH-3355 approved – Prior authorization for total hip (27130) 3 days ago
  • CLM-88274 completed – 98 claims, all clean 4 days ago
  • AUTH-3348 returned – Additional clinical documentation requested 4 days ago
  • CLM-88251 completed – Denial reprocessing finished 5 days ago
  • AUTH-3339 approved – Eligibility check for new member group 5 days ago
  • CLM-88219 completed – 210 claims processed under standard SLA 6 days ago
  • AUTH-3331 approved – Prior auth for knee arthroscopy (29881) 6 days ago
  • CLM-88187 completed – High-volume professional claims batch 1 week ago
  • AUTH-3324 approved – Facility claim authorization cleared 1 week ago
  • CLM-88152 completed – Coding review with 3 corrections applied 1 week ago
  • AUTH-3317 approved – Eligibility verification completed 8 days ago
  • CLM-88108 completed – 175 claims, SLA met at 3.2 hours 8 days ago
  • AUTH-3309 approved – Prior authorization for CPT 45378 9 days ago
  • CLM-88076 completed – Clean claim batch delivered 9 days ago
  • AUTH-3301 returned – Missing operative report requested 10 days ago
  • CLM-88041 completed – 132 claims processed successfully 10 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

Report example: Claims vs Prior Auth volume.

SLA Compliance Trend

Report example: On-time % – last 30 days.

Payer / Client Performance

Payer / Client Claims (30d) Auths (30d) On-Time % Accuracy Avg Turnaround
AIA Hong Kong Corporate 1,124 218 97.6% 99.3% 3.4h
AIA Singapore Group 892 195 96.1% 98.9% 3.9h
AIA Thailand Benefits 541 142 94.2% 98.7% 4.6h
AIA Malaysia Partners 284 92 98.0% 99.4% 3.1h

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