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TEST-CLAIM-00054
Synthetic BCBS-TX · Medical Necessity
Needs Clinical ReviewCritical
Denial
CO-55: Procedure/treatment is deemed experimental/investigational by the payer.
- Billed
- $2,751
- Denied
- $1,317
- Funnel stage
- Awaiting Review
- Service date
- Feb 11, 2026
- Denial date
- Mar 26, 2026
- Appeal deadline
- Jun 24, 2026
Procedure codes: CPT: 70981 · ICD: G43.20, E11.56
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 | 75% | $0.0022 | 4.1s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 85% | $0.0051 | 6.2s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 82% | $0.0340 | 37.9s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 88% | $0.0089 | 1.9s |