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TEST-CLAIM-00028
Synthetic Medicaid-TX · Documentation Request
Deadline MissedMissed
Denial
CO-252: An attachment/other documentation is required to adjudicate this claim.
- Billed
- $1,613
- Denied
- $1,240
- Funnel stage
- Awaiting Review
- Service date
- Apr 25, 2026
- Denial date
- May 14, 2026
- Appeal deadline
- Jun 13, 2026
Procedure codes: CPT: 38569, 70952, 43586 · ICD: I10.77, F32.95
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 | 95% | $0.0011 | 1.9s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 75% | $0.0024 | 3.5s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 75% | $0.0046 | 4.1s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 78% | $0.0262 | 26.9s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 88% | $0.0189 | 16.7s |