Medmonk v35-COPAY-FIX EOB Intake Portal

Medmonk

EOB Intake & Review Portal

Pending Cases

Awaiting review

In Review

Currently being processed

Completed Today

Avg. 11 min each

Needs Further Review

Flagged for follow-up

Cases In Review

Case ID	Patient	Payer	Plan Type	Assigned To	Status	Action
C-2026-0084	Margaret T. Collins	UnitedHealthcare	Medicare Adv.	Jane Doe	In Review
C-2026-0085	Robert J. Hernandez	Aetna Better Health	Managed Medicaid	Alex Rivera	Needs Review

Recent Pending Cases

Case ID	Patient	Payer	Documents	Received	Action
C-2026-0088	Susan M. Park	Humana	EOB, HCFA, Ins. Card	Today 9:14 AM
C-2026-0092	Daniel M. Reyes	BCBS Illinois	EOB, HCFA, Ins. Card	Today 11:22 AM

Pending Cases

Case ID	Patient Name	DOB	Payer	Plan Type	Documents	Received
C-2026-0088	Susan M. Park	03/15/1952	Humana	Medicare Adv.	EOB, HCFA, Ins. Card	Today 9:14 AM
C-2026-0089	David L. Foster	07/22/1948	Wellcare	Medicare	EOB, ERA	Today 8:47 AM
C-2026-0090	Latoya B. Williams	11/05/1985	Aetna Better Health (IL)	Managed Medicaid	EOB, HCFA, ERA, Ins. Card	Today 7:58 AM
C-2026-0091	James A. Nguyen	05/30/1979	BCBS Illinois	Commercial	EOB, HCFA	Yesterday 4:42 PM
C-2026-0092	Daniel M. Reyes	04/12/1988	BCBS Illinois	Commercial	EOB, HCFA, Ins. Card	Today 11:22 AM

Cases In Review

Case ID	Patient	Payer	Plan Type	Reviewer	Started	Status	Action
C-2026-0084	Margaret T. Collins	UnitedHealthcare	Medicare Adv.	Jane Doe	Today 10:02 AM	In Review
C-2026-0085	Robert J. Hernandez	Aetna Better Health	Managed Medicaid	Alex Rivera	Today 9:35 AM	Needs Further Review

Completed Cases

Case ID	Patient	Payer	Plan Type	Reviewer	Completed	Duration
C-2026-0083	Patricia L. Moore	Cigna Healthcare	Medicare Adv.	Jane Doe	Today 9:58 AM	9 min
C-2026-0082	Anthony R. Jackson	Wellcare (WellCare by Allwell)	Medicare	Alex Rivera	Today 9:31 AM	14 min
C-2026-0081	Maria E. Gonzalez	CountyCare (IL)	Managed Medicaid	Jane Doe	Today 8:55 AM	11 min
C-2026-0080	Thomas H. Bradley	BCBS Illinois	Commercial	Sam Lee	Yesterday 4:50 PM	8 min

Payers & Plan Reference Sourced from Medicare Part D BIN/PCN data & internal training

Payer	Plan Type	BIN	PCN Identifier	ID Pattern	Notes

Cases Today

+3 from yesterday

Avg Queue Age

1.4h

Oldest: 3.2h

Completion Rate

78%

Target: 85%

Flag Rate

Down 2% this week

Employee Performance

Reviewer	Completed	Avg. Time	Flagged	Flag Rate
Jane Doe	42	10 min	3	7%
Alex Rivera	38	12 min	5	13%
Sam Lee	29	9 min	2	7%
Maria Chen	51	8 min	1	2%

SLA Alerts 2 Overdue

Case ID	Reviewer	In Review	SLA Status	Action
C-2026-0085	Alex Rivera	3.2h	⚠ Overdue
C-2026-0084	Jane Doe	2.8h	⚠ Overdue
C-2026-0091	Sam Lee	1.1h	On Track	—

Reviewer Workload Balance

Reviewer	Active Cases	Load
Alex Rivera	8	Overloaded
Jane Doe	5	Moderate
Sam Lee	2	Available
Maria Chen	1	Available

Bottleneck Report — Longest In Review

Case ID	Reviewer	In Review Since	Wait Time
C-2026-0085	Alex Rivera	9:35 AM	3.2h
C-2026-0084	Jane Doe	10:02 AM	2.8h

Volume by Payer

Payer	Cases	% of Total
UnitedHealthcare	48	29%
Humana	35	21%
Aetna	30	18%
BCBS	27	16%
Wellcare	22	13%
Other	5	3%

Plan Type Breakdown

Plan Type	Cases	Avg. Time
Medicare Advantage	74	10 min
Medicare (Original)	38	12 min
Managed Medicaid	29	11 min
Commercial	21	8 min
Tricare / VA	5	14 min

Live Activity Feed● Live

Time	Reviewer	Action	Case ID	Details
10:14 AM	Jane Doe	Opened	C-2026-0084	Started intake review
10:02 AM	Jane Doe	Assigned	C-2026-0084	Case assigned from pending queue
9:58 AM	Jane Doe	Completed	C-2026-0083	Attested and submitted — 9 min
9:49 AM	Jane Doe	Opened	C-2026-0083	Started intake review
9:35 AM	Alex Rivera	Opened	C-2026-0085	Started intake review
9:31 AM	Alex Rivera	Completed	C-2026-0082	Attested and submitted — 14 min
9:14 AM	System	Received	C-2026-0088	New case received — Humana EOB
8:55 AM	Jane Doe	Completed	C-2026-0081	Attested and submitted — 11 min
8:47 AM	System	Received	C-2026-0089	New case received — Wellcare EOB
8:47 AM	Alex Rivera	Flagged	C-2026-0085	Sequestration amount mismatch

Attestation Audit Trail

Case ID	Reviewer	Attested At	Duration	Checklist Complete	Status
C-2026-0083	Jane Doe	Today 9:58 AM	9 min	All 4 items	Submitted
C-2026-0082	Alex Rivera	Today 9:31 AM	14 min	All 4 items	Submitted
C-2026-0081	Jane Doe	Today 8:55 AM	11 min	All 4 items	Submitted
C-2026-0080	Sam Lee	Yesterday 4:50 PM	8 min	All 4 items	Submitted
C-2026-0085	Alex Rivera	—	Active	Incomplete	Flagged

Incomplete Submission Log

Case ID	Reviewer	Attempted At	Blocked By
C-2026-0085	Alex Rivera	Today 9:52 AM	Checklist items unchecked
C-2026-0083	Jane Doe	Today 9:55 AM	Attestation box unchecked

Flag Rate by Reviewer

Reviewer	Cases	Flagged	Rate	Top Reason
Alex Rivera	38	5	13%	Seq. mismatch
Jane Doe	42	3	7%	Missing ERA
Sam Lee	29	2	7%	Payer unclear
Maria Chen	51	1	2%	Financial inconsistency

Error Pattern Report — Adj. Codes

Code	Description	Occurrences	% of Flags
`CO-253`	Sequestration	8	47%
`PR-3`	Member copay	4	24%
`CO-45`	Contractual adj.	3	18%
`CO-97`	Not covered	2	11%

Sequestration Discrepancy Tracker

Case ID	Payer	Expected	Recorded	Diff
C-2026-0085	Aetna Better Health	$18.20	$16.40	-$1.80
C-2026-0079	UnitedHealthcare	$22.10	$22.10	$0.00

Re-Review Rate

Reviewer	Completed	Re-reviewed	Rate
Jane Doe	42	2	5%
Alex Rivera	38	4	11%
Sam Lee	29	1	3%
Maria Chen	51	1	2%

Medicare Advantage — Sequestration Report (Adj. 253)

Case ID	Patient	Payer	Contract ID	Billed	Seq. Adj.	Plan Paid	Reviewer	Status
C-2026-0084	Margaret T. Collins	UnitedHealthcare	H0169	$8,400.00	-$24.30	$890.50	Jane Doe	In Review
C-2026-0083	Patricia L. Moore	Cigna Healthcare	H5410	$980.00	-$18.40	$712.60	Jane Doe	Complete
C-2026-0079	Dorothy R. Kim	Humana	H1036	$1,105.00	-$22.10	$843.90	Maria Chen	Complete

Weekly Performance Digest

Auto-generated every Monday. Includes volume, accuracy, flag rates, SLA compliance, and top reviewers for the prior week.

Week of March 16, 2026

Total Cases: 67 | Completed: 52 | Flagged: 6

Avg Review Time: 10.4 min | SLA Met: 89%

Top Reviewer: Maria Chen (51 cases, 2% flag rate)

Full Case History Export

Export all cases with reviewer, timestamps, attestation status, financial fields, and adjustment codes for billing or external audit submission.

Payer Turnaround Time

Payer	Cases	Avg. Review Time	Longest
UnitedHealthcare	48	10 min	24 min
Aetna Better Health	30	13 min	31 min
Humana	35	9 min	18 min
BCBS Illinois	27	11 min	22 min
Wellcare	22	12 min	28 min

Reviewer Accounts

Name	Email	Role	Status	Last Active
Jane Doe	jane@medmonk.com	Reviewer	Active	Today 10:14 AM
Alex Rivera	alex@medmonk.com	Reviewer	Active	Today 9:35 AM
Sam Lee	sam@medmonk.com	Reviewer	Active	Yesterday 4:50 PM
Maria Chen	maria@medmonk.com	Reviewer	Active	Today 8:30 AM

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Commercial Copay Cases

This month

Total Reimbursed

$9,400

Checks issued to facilities

Checks Pending

Awaiting issuance

Other Programs

PAP / Free Trial / Compassionate

Check Reimbursement Tracker — Commercial Copay

Case ID	Patient	Facility	Program	Check Amount	Check #	Issue Date	Status
C-2026-0084	Margaret T. Collins	Northshore Specialty Pharmacy	Octagam Copay	$500.00	OCT-2026-00847	Mar 18, 2026	Issued
C-2026-0083	Patricia L. Moore	Northshore Specialty Pharmacy	Octagam Copay	$500.00	OCT-2026-00831	Mar 15, 2026	Received
C-2026-0092	Daniel M. Reyes	Northshore Specialty Pharmacy	Wilate Copay	$750.00	—	—	Pending
C-2026-0081	Maria E. Gonzalez	Midwest Specialty Rx	Octagam Copay	$500.00	OCT-2026-00819	Mar 12, 2026	Received

Other Program Tracking — PAP / Free Trial / Compassionate Care

These programs are managed externally. This log is for internal reference only — enrollment, fulfillment, and reimbursement are handled directly by the manufacturer or program administrator.

Case ID	Patient	Program Type	Managed By	Enrollment Status	Notes
C-2026-0086	Linda K. Watts	Free Trial	Octapharma Direct	Enrolled	30-day free trial initiated
C-2026-0087	George T. Simmons	Compassionate Care	Octapharma Direct	Pending	Application submitted, awaiting approval
C-2026-0079	Dorothy R. Kim	PAP	Octapharma Direct	Active	Income verified, monthly supply approved

Program Breakdown

Program	Cases	Total Value
Commercial Copay Assistance	18	$9,400.00
PAP	5	Manufacturer managed
Free Trial	4	Manufacturer managed
Compassionate Care	4	Manufacturer managed

Facility Reimbursement Summary

Facility	Checks Issued	Total Paid	Pending
Northshore Specialty Pharmacy	8	$4,000.00	$750.00
Midwest Specialty Rx	5	$2,500.00	$0.00
Central Infusion Services	4	$2,000.00	$500.00
Other	2	$900.00	$0.00

EOB

HCFA 1500

ERA 835

Ins. Card

EOB Document

Uploaded by provider — click fields in extracted panel to highlight source location

EXPLANATION OF BENEFITS
 Payer: UnitedHealthcare (Medicare Advantage)
 Contract ID: H0169 | BIN: 610097 | PCN: 9999
 Member ID: 1AB2CD3EF45
 Member: MARGARET T COLLINS
 DOB: 03/12/1947 | Age: 78
 Group #: 80652 | Seq: 253


 Provider: NORTHSHORE SPECIALTY PHARMACY
 NPI: 1234567890
 Date of Service: 03/10/2026


 Rx #: 9201547 | NDC: 67467-0843-20
 Drug: Octagam 10% 20g/200mL
 Billed: $8,400.00
 Allowed: $8,232.00
 Sequestration (Adj 253): -$164.64
 Plan Paid: $7,567.36
 Member Copay: $500.00
 Member Responsibility: $500.00


 Adjustment Code 253 present — Medicare/Medicare Advantage
                  

AI Observations

Medicare/Medicare Advantage Patient — Age 78, Member ID pattern 1AB2CD3EF45 confirms Medicare Advantage. Sequestration Adj. Code 253 present on EOB. RxPCN: 9999 matches UHC Medicare Part D (BIN 610097). M3P/MPPP BIN confirmed.

️

Sequestration Applied: $164.64 reduction (Adj 253) per Medicare Advantage rules — confirm plan paid amount reflects 2% sequestration reduction from $8,232.00 → $7,567.36.

UHC Contract ID H0169 found in Part D reference. PCN 9999, BIN 610097 — consistent with M3P MPPP enrollment. Verify M3P payment spread if applicable.

AI-Assisted Intake — Case C-2026-0084

Review extracted fields, confirm accuracy, then submit. Highlighted fields need attention.

Medicare Advantage Overall: 94% Conf.

AI Extracted Data From EOB + HCFA + ERA + Card

Patient Information

Patient Name 99%

Margaret T. Collins

Date of Birth 99%

03/12/1947

Age 99%

78 yrs — ️ Medicare-eligible age

Address 97%

847 N. Elm St, Palatine IL 60074

Insurance / Payer

Payer 99%

UnitedHealthcare

Plan Type 99%

Medicare Advantage (Part C)

Contract ID 98%

H0169

Member ID 98%

1AB2CD3EF45

Group Number 96%

80652

RxBIN / PCN 99%

610097 / 9999

Claim / Service

Date of Service 99%

03/10/2026

Provider NPI 98%

1234567890

Rx Number 99%

9201547

NDC 97%

67467-0843-20

✓ AI Verified — Matches Octapharma NDC 67467-0843-20 (Octagam 10% 20g/200mL)

Drug / Service 98%

Octagam 10% 20g/200mL

Diagnosis Code 96%

D83.9

Financial

Billed Amount 99%

$8,400.00

Allowed Amount 98%

$8,232.00

Sequestration (Adj 253) 97%

-$24.30 ️ Confirm matches 2% calc

Plan Paid 88%

$890.50 ️ Verify after sequestration

Member Copay / Responsibility 97%

$500.00

Adjustment Codes 98%

CO-253, PR-3, CO-45

Intake Form Auto-filled — review & confirm

Patient Information

Patient Name

Date of Birth

Address

Insurance / Payer

Payer

Plan Type

Contract ID

Member ID

Group Number

RxBIN / PCN

Claim / Service

Date of Service

Provider / NPI

Rx Number

NDC

Drug / Service Description

Diagnosis Code(s)

Financial

Billed Amount

Allowed Amount

Sequestration Adj. (253)

Plan Paid

Member Copay / Responsibility

Adjustment Codes

Reviewer Notes

Copay Assistance & Patient Access

Commercial Plan

Program Benefit Limit

Annual Maximum: $25,000.00

Program Paid

$3,200.00

This Claim

$500.00

Remaining

$21,800.00

14% of annual limit used ($3,500.00 of $25,000.00 after this claim)

Copay Assistance Program

Program / Enrollment ID

Amount Requested

Copay Case ID

Dispensing Provider / Facility

Facility Name

Phone Number

Facility Address

Prescriber / Referral

Referring Physician / Prescriber Name

Clinical Notes / Additional Information

Review Checklist — Complete Before Attesting

Patient name and date of birth match the source documents Payer and plan type confirmed against insurance card and EOB Medicare / Medicare Advantage: Sequestration Adj. 253 verified — confirmed equals 2% of allowed amount and plan paid reflects correct net after sequestration and member copay Intake form fields corrected where needed and all required fields are complete

I confirm that I have reviewed all extracted fields, verified the highlighted amounts for accuracy, and that the information entered in the intake form is complete and correct to the best of my knowledge.