Governance System
Operational
All systems reserved

Plan GPS Dashboard

Governance pathways identified from claims evaluation.
Governance Lane Discovery
Care pathways where structured governance may reduce cost exposure or improve care routing.
Primary Recommended Pathway
MSK Care Pathway
54 claims flagged
28% of total spend
Metabolic Care Pathway
31 claims flagged
18% of total spend
Women's Health Pathway
18 claims flagged
11% of total spend
Claims Review Summary
252
Claims Evaluated
89
Matched to Governance Rules
54
Flagged for Pathway Evaluation
Last evaluation run: Today 2:14 PM
Governance Lane Evaluation Table
Claim ID
Procedure
Care Category
Lane Assignment
Status
CLM-1045
MRI Lumbar Spine
MSK
MSK Governance Lane
CLM-1082
Knee Arthroscopy
MSK
MSK Governance Lane
CLM-1103
Cortisone Injection
MSK
MSK Governance Lane
CLM-1178
A1C Panel
Metabolic
Metabolic Governance Lane
CLM-1201
Mammography
Women's Health
Women's Health Lane
Page 1 of 5
Claim ID
Procedure
Care Category
Lane Assignment
Status
CLM-1045
MRI Lumbar Spine
MSK
MSK Governance Lane
CLM-1082
Knee Arthroscopy
MSK
MSK Governance Lane
CLM-1103
Cortisone Injection
MSK
MSK Governance Lane
CLM-1178
A1C Panel
Metabolic
Metabolic Governance Lane
CLM-1201
Mammography
Women's Health
Women's Health Lane
Page 2 of 5
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