2,418
↑ 34 this month · 94% active
1,847
↑ 12% vs yesterday · 94% approved
ETB 42.8M
↑ 8% MoM · Target: ETB 50M
234
8 urgent >24h · SLA at risk
14
3 critical · ETB 2.1M at risk
Claims Volume — Daily (May 2025)
🚨 Active Fraud Alerts
Critical: Duplicate claim ring detected — 3 providers, ETB 480K exposure.
4m ago
Warning: Upcoding pattern flagged for Provider P-1442 — orthopedic claims 3× benchmark.
1h ago
Warning: Ghost member ID ETH-2024-09921 used across 4 separate facilities this week.
3h ago
Info: High-volume pharmacy P-0873 submitted 140 claims in 6 hours. Auto-flagged for review.
5h ago
⏱ Auth Queue Snapshot
Total in queue234
Urgent (>24h)8
Avg processing time18h 24m
Auto-approved today1,124
SLA compliance rate96.4%
Provider Quality Distribution
Network Avg Quality Score
84.2 /100
↑ +2.1 from Q4 2024
Financial Summary — May 2025
Total Claims ValueETB 68.4M
Approved Claims ValueETB 64.3M
Paid to ProvidersETB 42.8M (66.6%)
Outstanding (ETB)ETB 21.5M
Rejected Claims ValueETB 4.1M
Fraud Saved YTDETB 2.1M
Admin Fee RevenueETB 1.93M
Avg Settlement Time4.2 days
Recent Claims — Network Wide
| Claim ID | Provider | Member | Service | Amount | Submitted | Status |
|---|
| CLM-20942 | Black Lion Hospital | ETH-2024-01829 | Surgery — Major | ETB 42,000 | 08 May 14:28 | Approved |
| CLM-20941 | Bethzatha General | ETH-2024-00847 | Inpatient — 4 days | ETB 18,400 | 08 May 14:15 | Under Review |
| CLM-20940 | Galen Diagnostic | ETH-2024-01124 | MRI — Brain | ETB 9,200 | 08 May 13:52 | Pending |
| CLM-20939 | Addis Pharmacy Net | ETH-2024-01389 | Pharmacy — Chronic | ETB 3,400 | 08 May 13:40 | Approved |
| CLM-20938 | Provider P-0873 | ETH-2024-09921 | OPD × 12 visits | ETB 12,000 | 08 May 12:20 | 🚨 Fraud Review |
| CLM-20937 | Landmark Intl Hosp. | ETH-2024-00583 | Cardiology — OPD | ETB 6,800 | 08 May 11:55 | Approved |
| CLM-20936 | NovaDent Network | ETH-2024-01201 | Dental — Extraction | ETB 2,800 | 08 May 11:30 | Approved |
| CLM-20935 | Jimma Univ. Med. | ETH-2024-00982 | Surgery — Laparoscopic | ETB 28,500 | 08 May 10:44 | Rejected |
New Provider Applications
Applications this month48
Under credentialing review23
Approved this month19
Rejected / Incomplete6
Avg credentialing time9.2 days