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TEST-CLAIM-00032
Synthetic Aetna · Coding
Needs Clinical ReviewApproaching
Denial
CO-4: The procedure code is inconsistent with the modifier used.
- Billed
- $1,424
- Denied
- $1,036
- Funnel stage
- Awaiting Review
- Service date
- Oct 30, 2025
- Denial date
- Jan 9, 2026
- Appeal deadline
- Jul 8, 2026
Procedure codes: CPT: 54092, 13761 · ICD: N39.23, R07.27
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% | $0.0010 | 1.8s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 72% | $0.0021 | 3.4s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 82% | $0.0048 | 4.7s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 78% | $0.0227 | 23.8s |
| Quality Checker | Failed | claude-sonnet-4-6 · v1 | — | $0.0000 | — |