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December 2025 — before submission

Pre-submission · Single patient · Venus Medicare Limited

Total billed
₦279,417.80
Potentially approved
₦75,045.32
Survives every check the app could actually make
At risk
₦135,240.00
Breaks a rule your documents do state
Cannot be assessed
₦69,132.48
Not judged either way — the knowledge to judge it is missing

₦69,132.48 of this claim has not been judged either way. That is not a prediction that it will be refused — it is the app declining to guess where your knowledge base has a gap. The findings below name each gap. Closing them moves this money into one of the other two columns.

What the HMO is unlikely to pay

Written for you, not for the HMO. Use the (?) on a finding to see what Mimi thinks beyond what the documents say.

  • Pre-Authorization required and no code recorded

    ₦42,000.00 at risk

    KULUWA AL-MUSTAPHA · CONSULT · 09 Dec 2025 · row 9

    At ₦42,000.00 this line is above the ₦40,000.00 Pre-Authorization threshold in the Venus Medicare Limited agreement, and no code is recorded for the service on 09 Dec 2025. On the agreement as it stands, the whole ₦42,000.00 is at risk — not a part of it.

    • Cites: Venus Medicare Limited SLA — Pre-Authorization threshold — entered by the officer from the signed agreement
    What do you think?

    Opinion — not from your documents

    If a code was in fact obtained and simply not captured on the bill, retrieving it before submission converts a total loss into a paid line. That is worth checking with the front desk first. If no code was obtained and the case was an emergency, the emergency clause is the only route left, and it usually has a short notification window attached.

  • Pre-Authorization required and no code recorded

    ₦93,240.00 at risk

    KULUWA AL-MUSTAPHA · LAB · 09 Dec 2025 · row 10

    At ₦93,240.00 this line is above the ₦40,000.00 Pre-Authorization threshold in the Venus Medicare Limited agreement, and no code is recorded for the service on 09 Dec 2025. On the agreement as it stands, the whole ₦93,240.00 is at risk — not a part of it.

    • Cites: Venus Medicare Limited SLA — Pre-Authorization threshold — entered by the officer from the signed agreement
    What do you think?

    Opinion — not from your documents

    If a code was in fact obtained and simply not captured on the bill, retrieving it before submission converts a total loss into a paid line. That is worth checking with the front desk first. If no code was obtained and the case was an emergency, the emergency clause is the only route left, and it usually has a short notification window attached.

  • The plan "VML EXCLUSIVE FAMILY" is not set up for Venus Medicare Limited

    ₦69,132.48 at risk

    3 lines worth ₦69,132.48 name the plan "VML EXCLUSIVE FAMILY", which does not exist under Venus Medicare Limited in the app. Either the plan is missing from setup, or the name on the bill differs from what the HMO calls it. Both are worth resolving before the claim goes out.

    • Cites: Venus Medicare Limited — plan setup

Documents

Any format. A returned sheet carrying approved amounts is recognised as the HMO's reply and switches this to a reconciliation.

No documents attached

Claim schedule

8 lines as parsed from your documents. Diagnosis is carried because the claim needs it; no finding reasons from it.

  • CONSULT

    ₦22,200.00

    KULUWA AL-MUSTAPHA · GOLD FAMILY CAT. 2B (NR) · 04 Dec 2025

    PA: NIL

  • DRUGS

    ₦13,440.32

    KULUWA AL-MUSTAPHA · GOLD FAMILY CAT. 2B (NR) · 04 Dec 2025

    PA: NIL

  • LAB

    ₦39,405.00

    KULUWA AL-MUSTAPHA · GOLD FAMILY CAT. 2B (NR) · 04 Dec 2025

    PA: NIL

  • CONSULT

    ₦42,000.00

    KULUWA AL-MUSTAPHA · GOLD FAMILY CAT. 2B (NR) · 09 Dec 2025

    PA: NIL1 finding

  • LAB

    ₦93,240.00

    KULUWA AL-MUSTAPHA · GOLD FAMILY CAT. 2B (NR) · 09 Dec 2025

    PA: NIL1 finding

  • CONSULT

    ₦22,200.00

    SULAIMAN NASIR · VML EXCLUSIVE FAMILY · 03 Dec 2025

    PA: NIL

  • CONSULT

    ₦22,200.00

    SULAIMAN NASIR · VML EXCLUSIVE FAMILY · 04 Dec 2025

    PA: NIL

  • LAB

    ₦24,732.48

    SULAIMAN NASIR · VML EXCLUSIVE FAMILY · 04 Dec 2025

    PA: NIL

Ask about this analysis

Answers come only from the documents attached here and the provider's approved knowledge. Anything outside that is labelled.

No Anthropic API key is configured, so this feature is switched off. Everything that can be checked by rule — tariff prices, missing authorization codes, duplicates, arithmetic, date variance — has still run and is shown above. Add ANTHROPIC_API_KEY to the environment to turn on document reading, scanned-document transcription and chat.

  • How did you drive at this

  • Cannot answer from the documents provided

    Chat needs an Anthropic API key, which is not configured. The rule-based findings on this analysis are unaffected and remain complete.

Delete this analysis and everything attached to it.