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TEST-CLAIM-00058
Synthetic UHC · Medical Necessity
Needs Clinical ReviewApproaching
Denial
CO-55: Procedure/treatment is deemed experimental/investigational by the payer.
- Billed
- $8,298
- Denied
- $7,545
- Funnel stage
- Awaiting Review
- Service date
- Jan 24, 2026
- Denial date
- Apr 9, 2026
- Appeal deadline
- Jul 8, 2026
Procedure codes: CPT: 71385 · ICD: I10.96
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% | $0.0011 | 1.7s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 75% | $0.0022 | 8.9s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 85% | $0.0051 | 7.0s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 82% | $0.0277 | 29.8s |
| Quality Checker | Failed | claude-sonnet-4-6 · v1 | — | $0.0000 | — |