Rejection Repair
Ashan's deterministic 'If A, Then B' rules engine identifies predictable structural claim errors before they become full insurance denials.
Ashan does not automatically alter production claims in this demonstration. Human approval and approved production integrations are required.
Rejections Detected
143
Auto-Repair Eligible
112
Requires Human Review
31
Successfully Repaired
84
Cash Protected
$58,200
Rejection queue
| Claim | Payer | Code | Reason | Detected issue | Suggested repair | Confidence | Status | Action |
|---|---|---|---|---|---|---|---|---|
| CLM-20500 | MetroChoice Health | 16 | Missing subscriber ID | Subscriber ID blank | Auto-populate from eligibility check | 91% | Repaired | |
| CLM-20501 | UnityCare Insurance | 31 | Invalid date format | DOS format MM/DD/YY | Convert to CCYYMMDD | 79% | Pending | |
| CLM-20502 | UnityCare Insurance | 197 | Prior auth sequence | Auth # not in PWK01 | Move auth to correct loop/segment | 97% | Manual Review | |
| CLM-20503 | National Benefit Partners | A3 | Invalid payer ID | Legacy payer ID 9999 | Replace with current 87726 | 93% | Pending | |
| CLM-20504 | Summit Blue | 21 | Demographic mismatch | DOB mismatch w/ payer | Update DOB from eligibility 271 | 87% | Repaired | |
| CLM-20505 | Horizon Health Plan | 18 | Formatting issue | NPI in REF instead of NM1 | Move NPI to NM109 | 70% | Pending | |
| CLM-20506 | MetroChoice Health | 16 | Missing subscriber ID | Subscriber ID blank | Auto-populate from eligibility check | 77% | Pending | |
| CLM-20507 | UnityCare Insurance | 31 | Invalid date format | DOS format MM/DD/YY | Convert to CCYYMMDD | 93% | Pending | |
| CLM-20508 | National Benefit Partners | 197 | Prior auth sequence | Auth # not in PWK01 | Move auth to correct loop/segment | 81% | Manual Review | |
| CLM-20509 | National Benefit Partners | A3 | Invalid payer ID | Legacy payer ID 9999 | Replace with current 87726 | 78% | Pending | |
| CLM-20510 | National Benefit Partners | 21 | Demographic mismatch | DOB mismatch w/ payer | Update DOB from eligibility 271 | 83% | Pending | |
| CLM-20511 | MetroChoice Health | 18 | Formatting issue | NPI in REF instead of NM1 | Move NPI to NM109 | 87% | Pending | |
| CLM-20512 | MetroChoice Health | 16 | Missing subscriber ID | Subscriber ID blank | Auto-populate from eligibility check | 90% | Pending | |
| CLM-20513 | UnityCare Insurance | 31 | Invalid date format | DOS format MM/DD/YY | Convert to CCYYMMDD | 75% | Pending | |
| CLM-20514 | UnityCare Insurance | 197 | Prior auth sequence | Auth # not in PWK01 | Move auth to correct loop/segment | 87% | Repaired | |
| CLM-20515 | Horizon Health Plan | A3 | Invalid payer ID | Legacy payer ID 9999 | Replace with current 87726 | 86% | Manual Review | |
| CLM-20516 | UnityCare Insurance | 21 | Demographic mismatch | DOB mismatch w/ payer | Update DOB from eligibility 271 | 94% | Repaired | |
| CLM-20517 | UnityCare Insurance | 18 | Formatting issue | NPI in REF instead of NM1 | Move NPI to NM109 | 72% | Pending |