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TEST-CLAIM-00030
Synthetic Medicaid-TX · Medical Necessity
Needs Clinical ReviewCritical
Denial
CO-55: Procedure/treatment is deemed experimental/investigational by the payer.
- Billed
- $3,315
- Denied
- $2,231
- Funnel stage
- Awaiting Review
- Service date
- Feb 26, 2026
- Denial date
- May 27, 2026
- Appeal deadline
- Jun 26, 2026
Procedure codes: CPT: 58571, 19038, 76317 · ICD: M17.53, R07.13
Appeal
A draft appeal has been produced.
AI pipeline trace (5 runs)
| Step | Status | Model · prompt | Confidence | Cost | Latency |
|---|---|---|---|---|---|
| Classifier | Succeeded | claude-haiku-4-5 · v2 | 90% | $0.0012 | 2.0s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 72% | $0.0027 | 4.3s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 82% | $0.0055 | 4.0s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 82% | $0.0363 | 41.7s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 85% | $0.0241 | 18.3s |