← Revenue worklist
REV-CLM-3102
UnderpaymentDisputedFictional TRH demo — synthetic claim id · no PHIBlue Cross and Blue Shield of Texas · Inpatient surgery · DRG 470 (Major joint replacement)
Expected-vs-paid calculation
Expected (contract allowed)
$24,800
Paid (remittance)
$22,140
Variance
$2,660
Rate basis: DRG $21,300 + implant pass-through $3,500
Contract term: BCBSTX Exhibit 2 §5 Implant carve-out
Denial / adjustment reason: Implant carve-out not applied
Ownership & confidence
- Owner
- C. Ford
- Confidence
- 82 / 100
- Claim age
- 63 days
- Recovery action
- Rebill implant carve-out with invoice; cite Exhibit 2 §5.
Evidence provenance
- Evidence
- BCBSTX 835 batch B · line 12
- Linked agreement
- Statewide Blue Plan Participation Agreement
- Linked payer
- Blue Cross and Blue Shield of Texas
Recovery workflow
Demo action — resets on reload · not persistedChronology & session activity
- seed2026-05-09 — REV-CLM-3102 surfaced by VERIFY expected-vs-paid rule from the 835/837 batch extract · FY2026 Q3 (Apr–Jun 2026).
- seed2026-05-09 — Contract term matched; expected allowed amount recomputed from loaded rate basis.