← Revenue worklist
REV-CLM-3002
DenialDisputedFictional TRH demo — synthetic claim id · no PHIUnitedHealthcare · Outpatient surgery · APC 5375 (Level 5 ortho)
Expected-vs-paid calculation
Expected (contract allowed)
$9,240
Paid (remittance)
$0
Variance
$9,240
Rate basis: APC allowed $9,240
Contract term: UHC §7.1 Prior-authorization
Denial / adjustment reason: CO-197 precert absent on file
Ownership & confidence
- Owner
- C. Ford
- Confidence
- 71 / 100
- Claim age
- 52 days
- Recovery action
- Appeal with retro-authorization evidence; escalate to JOC if upheld.
Evidence provenance
- Evidence
- UHC 835 denial batch B · line 44
- Linked agreement
- Commercial Payer Participation Agreement
- Linked payer
- UnitedHealthcare
Recovery workflow
Demo action — resets on reload · not persistedChronology & session activity
- seed2026-05-21 — REV-CLM-3002 surfaced by VERIFY expected-vs-paid rule from the 835/837 batch extract · FY2026 Q3 (Apr–Jun 2026).
- seed2026-05-21 — Contract term matched; expected allowed amount recomputed from loaded rate basis.