MediConCen MediConCen FWA Routing
CLM-2026-003847 INPATIENT RED · HIGH RISK
Chan Wei Ming · City Medical Centre · HK$84,200 · J18.9 Pneumonia
Auto-Classification & Routing — Criteria-based, no manual intervention required AUTO-CLASSIFIED
Risk Score
87
RED
Routing criteria matched
Routed To
Senior Fraud Assessor
Fraud Investigation Team
Dr. Helen Wong
Routing Criteria Applied All criteria evaluated automatically on ingestion
AI-Synthesised Member & Provider View — Underwriting history · prior claims · provider risk
AI SYNTHESIS
GPT-ASSISTED
Underwriting History
Prior Claims (24 months)
PROVIDER
HIGH RISK
Triggered FWA Checks — Each check with full rationale
3 RED 1 AMBER 1 GREEN
Recommended Actions — Decision support with documented justification
ACTION
Assessor Assignment & Concurrent Review — Confirm routing or override
Available Assessors
Auto-recommended based on risk level and speciality
PENDING CONFIRMATION
Auto-routing selected Dr. Helen Wong based on risk score ≥ 80 and fraud speciality match.
CONCURRENT REVIEW
OPTIONAL
Flag this claim for concurrent review — two assessors evaluate independently, results merged before decision. Recommended for claims > HK$50,000 with active investigations.
ROUTING ENGINE
Live
RISK SCORE 87 / 100
RAG RED
AMOUNT HK$84,200
Queue: