Claim Analysis Viewer - AI Bridge Demo

📋 Claim Details

Claim Number

CLM-2025-45892

Member ID

MEM-78453

Submission Date

Dec 10, 2025

Policy ID

POL-33291

⚙️ Processing Timeline

Data Extraction Complete

Retrieved claim from SQL Server, member history, and policy documents from SharePoint

⏱️ 0.3s

PII Masking Applied

Tokenized member name, DOB, and SSN before LLM processing

⏱️ 0.1s

Context Aggregation

Combined data from 3 sources into unified context

⏱️ 0.2s

LLM Analysis

GPT-4 analyzed 2,847 tokens with structured output

⏱️ 1.2s

Schema Validation

Pydantic validated response against ClaimAnalysis model

⏱️ 0.05s

PII Re-hydration

Replaced tokens with actual data in secure backend layer

⏱️ 0.05s

🤖 AI Analysis Result

Reasoning Steps

1 Verified procedure code matches policy-covered diagnostic imaging services

2 Confirmed pre-authorization from primary care physician is present in submitted documents

3 Cross-referenced member's prior claim history - no duplicate services found

Referenced Policy Sections

Section 3.2.A - Diagnostic Imaging

Covered procedures include diagnostic imaging (MRI, CT, X-ray) when medically necessary and pre-authorized by primary care physician. Maximum benefit: $5,000 per calendar year.

Section 1.4.B - Pre-Authorization Requirements

All diagnostic imaging procedures require pre-authorization within 48 hours of service request. Authorization must include medical necessity documentation and procedure codes.

🔒 Data Privacy & PII Protection

All personally identifiable information (PII) is tokenized before being sent to the LLM. The system uses AES-256 encryption and maintains zero-retention policy for external API calls.

Data Field	Original Value	Masked Value (to LLM)	Status
Member Name	John Smith	`TOKEN_A7F3E9D2F8B1C5E6`	Masked
Date of Birth	1980-03-15	`TOKEN_B8G4F0E3A2D7C9H1`	Masked
SSN	123-45-6789	`TOKEN_C9H5G1F4B3E8D0I2`	Masked
Claim Amount	$3,245.00	$3,245.00	Not PII
Procedure Code	CPT-70552	CPT-70552	Not PII

HIPAA Compliance: All PII tokens are cleared from memory immediately after processing (zero retention). The actual data is only re-hydrated in the secure FastAPI backend layer and never exposed to external services.