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TEST-CLAIM-00012
Synthetic Humana · Coding
Needs Clinical ReviewOn Track
Denial
CO-4: The procedure code is inconsistent with the modifier used.
- Billed
- $7,053
- Denied
- $2,918
- Funnel stage
- Awaiting Review
- Service date
- Apr 16, 2026
- Denial date
- Jun 21, 2026
- Appeal deadline
- Aug 20, 2026
Procedure codes: CPT: 64040 · ICD: I10.94
Appeal
A draft appeal has been produced.
AI pipeline trace (6 runs)
| Step | Status | Model · prompt | Confidence | Cost | Latency |
|---|---|---|---|---|---|
| Classifier | Failed | claude-haiku-4-5 · v2 | — | $0.0000 | — |
| Classifier | Succeeded | claude-haiku-4-5 · v2 | 95% | $0.0011 | 1.8s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 75% | $0.0021 | 3.8s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 82% | $0.0049 | 4.9s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 78% | $0.0285 | 30.9s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 91% | $0.0164 | 13.1s |