Auto-Approval Rules
Configure when claims require manual review before submission
How Auto-Approval Works
Claims are automatically approved for submission unless one of the review triggers below fires. When a trigger fires, the claim is flagged for manual review in the Workbench.
87%
Auto-Approved (Last 30 Days)
13%
Required Review (Last 30 Days)
Active Review Triggers
Review Triggers
Claims matching ANY of these conditions require manual review
High Value Claims
Review claims above a dollar threshold
Above
$
Triggered: 156 times (last 30 days)
Last: 2 hours ago
Disabled
First-Time Vendor
Review the first claim submitted to any vendor
No configuration needed
Triggered: 12 times (last 30 days)
Last: 5 days ago
Disabled
High Denial Rate
Review claims for vendors with historically high denial rates
Denial rate above
%
Triggered: 34 times (last 30 days)
Last: 1 day ago
Disabled
Significant Variance
Review claims that differ significantly from historical average
Variance above
%
Triggered: 0 times (last 30 days)
Never
Disabled