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TEST-CLAIM-00097
Synthetic Medicaid-TX · Medical Necessity
Needs Clinical ReviewApproaching
Denial
CO-55: Procedure/treatment is deemed experimental/investigational by the payer.
- Billed
- $8,769
- Denied
- $3,018
- Funnel stage
- Awaiting Review
- Service date
- Mar 31, 2026
- Denial date
- Jun 14, 2026
- Appeal deadline
- Jul 14, 2026
Procedure codes: CPT: 14847, 48462 · ICD: M17.25
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 | 90% | $0.0011 | 1.7s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 78% | $0.0024 | 3.7s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 78% | $0.0057 | 5.1s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 75% | $0.0283 | 31.4s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 85% | $0.0199 | 16.1s |