2/23/2026 2:24 AM
2/23/2026 2:24 AM Financial Control (Payment) Summary Claims Total Paid for Week $3,846,716.27 Claims Total Paid YTD $12,403,202.78 Claims Total Paid SFYTD $28,277,785.87 Number Claims Processed YTD 21,976 Number Claims Processed SFYTD 65,158 Number Claims Processed for the Week 4,386 Number Claims Denied for the Week 347 Percent of Claims Denied for the Week 7.9 Add Pay Weekly Count Beg. Inv. Claims Rec'd Claims Proc'd End Inv. Days on Hand Add Pay Weekly Amount CMS 1500 UB04 Members ADA Number of Members (Current Month) 18,729 Totals Newly Eligible Members (Current Month) 100 Number of Members (Last Month) 19,396 Number Termed (Current Month) 12 Inventory Received Processed On Hand Number Termed (Last Month) 767 0-10 Days 11-20 Provider Enrollment 21-30 Mailroom ( TO BE DETERMINED ) Enrolled Providers 1,106 Over 30 On Island Providers 290 Totals Off Island Providers 816 PayTo Providers 923 Credentialed 546 Provisional 538 Provider Updates Processed 32 CMS 1500 44 1,681 56 2,140 0 87.40 82 3,821 Number Termed Providers (Prev. …
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2/23/2026 2:24 AM Financial Control (Payment) Summary Claims Total Paid for Week $3,846,716.27 Claims Total Paid YTD $12,403,202.78 Claims Total Paid SFYTD $28,277,785.87 Number Claims Processed YTD 21,976 Number Claims Processed SFYTD 65,158 Number Claims Processed for the Week 4,386 Number Claims Denied for the Week 347 Percent of Claims Denied for the Week 7.9 Add Pay Weekly Count Beg. Inv. Claims Rec'd Claims Proc'd End Inv. Days on Hand Add Pay Weekly Amount CMS 1500 UB04 Members ADA Number of Members (Current Month) 18,729 Totals Newly Eligible Members (Current Month) 100 Number of Members (Last Month) 19,396 Number Termed (Current Month) 12 Inventory Received Processed On Hand Number Termed (Last Month) 767 0-10 Days 11-20 Provider Enrollment 21-30 Mailroom ( TO BE DETERMINED ) Enrolled Providers 1,106 Over 30 On Island Providers 290 Totals Off Island Providers 816 PayTo Providers 923 Credentialed 546 Provisional 538 Provider Updates Processed 32 CMS 1500 44 1,681 56 2,140 0 87.40 82 3,821 Number Termed Providers (Prev. Month) 4 UB04 2.4 10 97.6 402 0 93 93.10 412 Number of Termed Providers (Week) 0 ADA 100 153 0 0 0 56.90 74.20 153 Number of Providers on Pay Hold 5 Total Vol. 42 1,844 58 2,542 0 86.90 82.40 4,386 * Pharmacy 0 0 0 0 0 Prior Authorizations PA's (Current Month) 16,284 PA's (Week) 187 Change Requests Type Submitted Queued Development Resolved SIT Integrate SIT Test UAT Integrate UAT Test PROD Integrate PROD On Hold OnGoing PI_ Monitoring Total Billable 1 1 1 1 0 0 0 3 0 0 1 0 0 12 Non-Billable 0 2 5 2 0 0 0 0 1 0 2 2 0 14 Total CRs 1 3 6 3 0 0 0 3 1 0 3 2 0 26 Weekly CR Submitted Billable 0 Non-Billable 0 SOWs Due to USVI Billable 0 * YTD = Calendar Year to Date * SFYTD = October 1 to September 30 Awaiting USVI Closed SOW_ Processing % DDE Claims 90.70 98.50 54.30 90.10 4 0 4 0 0 % Paid in 30 Days Processed in 30 Days % of Auto Adj. Date of Oldest Batch Total Paper Claims Processed Reversal 402 226 3,567 4,808 DDE Claim Vol. % EDI Claims EDI Claim Vol. p Claim Vol. Total Paper Claims Received Date of Oldest Batch Reversal Replacements (Adjustments) and Voids ( TO BE DETERMINED ) *Open & Void are excluded from 'Processed' Counts * Pharmacy is not included in the Total Volume. CIGNA processes Pharmacy claims through a PBM USVI Dashboard for Week Ending Data Entry ( TO BE DETERMINED ) In Process Received Closed Provider Inquiry EDI Provider Enrollment Recipient/Member Call Center Total Claims Processed Total Volume 5 2/15/2026 0 1 0 0 613 0 1 0 0 0 0 0 0 Pends Government Provider's Financial Control (Payment) Summary Weekending Provider Name Claims Total Paid for Week DOH, GOVERNMENT OF THE VI, CHARLES HARWOOD COMPLEX $1,206.32 FREDERIKSTED HEALTH CARE, INC. $204,345.77 GOVERNOR JUAN F LUIS HOSPITAL / ESRD $54,894.47 GOVERNOR JUAN F. LUIS HOSPITAL AND MEDICAL CENTER $36,166.43 MYRAH KEATING SMITH COMMUNITY HOSPITAL $16,925.02 RLS COMMUNITY HEALTH CENTER $0.00 ROY L. SCHNEIDER HOSPITAL $147,558.18 ST THOMAS EAST END MEDICAL CENTER CORP $30,305.45 2/15/2026 Claims Total Paid YTD Claims Total Paid SFYTD Number Claims Processed YTD Number Claims Processed SFYTD $19,979.28 $54,962.01 249 703 $1,633,406.66 $3,666,500.92 4,732 11,231 $118,369.53 $202,510.01 49 108 $398,963.16 $773,604.54 450 1,117 $32,944.63 $120,446.33 121 308 $0.00 $0.00 91 228 $1,807,777.58 $4,489,086.72 1,491 4,216 $242,498.87 $920,310.67 1,708 6,165 Number Claims Processed for the Week Number Claims Denied for the Week Percent of Claims Denied for the Week 21 2 9.5 1,028 4 0.3 7 0 0.0 76 5 6.5 13 1 7.6 1 1 100.0 294 5 1.7 397 1 0.2