Workflow Automation — Prototype PRD
1. Product Overview
This app automates claims triage for healthcare organizations. It targets claims processors at Summit Health Plan. The app uses AI to enhance efficiency, reduce fraud, and streamline claim resolution.
2. Users
- Primary User: Claims Processor
- Secondary User: Claims Manager
3. Core Workflow
- User uploads claim data via the dashboard.
- System analyzes claims for DRG, fraud signals, and pended reason codes.
- User reviews automated triage results.
- User resolves claims and logs outcomes.
4. Key Features
- Claim Upload — Users can easily drag and drop claim files for processing.
- Automated Analysis — The system utilizes AI to review claims for key metrics.
- Triage Dashboard — Displays triage results with actionable insights and fraud alerts.
- Outcome Logging — Users can record resolutions directly in the app for future reference.
- Notification System — Alerts users of pending issues and updates on claim statuses.
5. Sample Data
- Claim ID: 12345, Provider: ABC Health, Status: Pending
- Claim ID: 67890, Provider: XYZ Clinics, Status: Under Review
- Claim ID: 11223, Provider: Health Network, Status: Approved
6. Design Notes
- Single-page Next.js app with Shadcn UI and Tailwind CSS, featuring dark mode.
- Dashboard layout includes a sidebar for navigation.
- Populate app with realistic mock data; avoid empty states.
- Focus exclusively on core workflow; no authentication or settings implemented.
- Use common lucide-react icons: Home, Settings, BarChart3, Users, FileText, Search, Bell, ChevronRight.