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TEST-CLAIM-00065
Synthetic Aetna · Medical Necessity
Needs Clinical ReviewApproaching
Denial
CO-50: These services are not deemed a medical necessity by the payer.
- Billed
- $1,229
- Denied
- $1,047
- Funnel stage
- Awaiting Review
- Service date
- Jan 5, 2026
- Denial date
- Jan 22, 2026
- Appeal deadline
- Jul 21, 2026
Procedure codes: CPT: 52437, 12068, 32838 · ICD: M17.16, S82.67
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 | 2.4s |
| Evidence Extractor | Succeeded | claude-haiku-4-5 · v2 | 72% | $0.0024 | 3.9s |
| Policy Checker | Succeeded | claude-sonnet-4-6 · v2 | 72% | $0.0054 | 5.2s |
| Appeal Drafter | Succeeded | claude-sonnet-4-6 · v2 | 72% | $0.0316 | 35.7s |
| Quality Checker | Succeeded | claude-sonnet-4-6 · v1 | 88% | $0.0230 | 19.6s |