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TEST-CLAIM-00088
Synthetic Aetna · Medical Necessity
Needs Clinical ReviewCritical
Denial
CO-55: Procedure/treatment is deemed experimental/investigational by the payer.
- Billed
- $4,260
- Denied
- $2,603
- Funnel stage
- Awaiting Review
- Service date
- Oct 31, 2025
- Denial date
- Dec 30, 2025
- Appeal deadline
- Jun 28, 2026
Procedure codes: CPT: 68841, 40671 · ICD: K21.60
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 | 92% | $0.0012 | 1.9s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 75% | $0.0026 | 10.6s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 82% | $0.0054 | 5.1s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 78% | $0.0367 | 42.4s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 88% | $0.0250 | 20.6s |