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TEST-CLAIM-00070
Synthetic Medicaid-TX · Medical Necessity
Needs Clinical ReviewCritical
Denial
CO-55: Procedure/treatment is deemed experimental/investigational by the payer.
- Billed
- $3,679
- Denied
- $2,550
- Funnel stage
- Awaiting Review
- Service date
- Apr 28, 2026
- Denial date
- May 28, 2026
- Appeal deadline
- Jun 27, 2026
Procedure codes: CPT: 97819, 26021 · ICD: N39.85, S82.92
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 | 85% | $0.0012 | 1.8s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 78% | $0.0025 | 4.0s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 82% | $0.0048 | 13.8s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 78% | $0.0270 | 29.5s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 85% | $0.0193 | 16.6s |