← Revenue worklist
REV-CLM-3001
UnderpaymentAssignedFictional TRH demo — synthetic claim id · no PHIUnitedHealthcare · Inpatient medical · DRG 291 (Heart failure w/ MCC)
Expected-vs-paid calculation
Expected (contract allowed)
$18,420
Paid (remittance)
$15,930
Variance
$2,490
Rate basis: DRG base $16,100 × 1.144 severity
Contract term: UHC §4.2 DRG base rate + outlier
Denial / adjustment reason: CO-45 contractual adj beyond fee schedule
Ownership & confidence
- Owner
- C. Ford
- Confidence
- 86 / 100
- Claim age
- 38 days
- Recovery action
- File underpayment project with UHC provider rep citing §4.2 outlier clause.
Evidence provenance
- Evidence
- UHC 835 batch A · line 118
- Linked agreement
- Commercial Payer Participation Agreement
- Linked payer
- UnitedHealthcare
Recovery workflow
Demo action — resets on reload · not persistedChronology & session activity
- seed2026-06-04 — REV-CLM-3001 surfaced by VERIFY expected-vs-paid rule from the 835/837 batch extract · FY2026 Q3 (Apr–Jun 2026).
- seed2026-06-04 — Contract term matched; expected allowed amount recomputed from loaded rate basis.