← Triage Tracker
TEST-CLAIM-00091
Synthetic BCBS-TX · Medical Necessity
Needs Clinical ReviewOn Track
Denial
CO-55: Procedure/treatment is deemed experimental/investigational by the payer.
- Billed
- $9,283
- Denied
- $5,361
- Funnel stage
- Awaiting Review
- Service date
- Apr 22, 2026
- Denial date
- Jun 19, 2026
- Appeal deadline
- Sep 17, 2026
Procedure codes: CPT: 40903, 60615 · ICD: N39.28
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 | 85% | $0.0011 | 1.8s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 78% | $0.0022 | 3.9s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 78% | $0.0051 | 4.7s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 78% | $0.0291 | 32.0s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 91% | $0.0104 | 4.7s |