← Revenue worklist
REV-CLM-3201
UnderpaymentValidatedFictional TRH demo — synthetic claim id · no PHIAetna · Outpatient surgery · APC 5313 (Level 3 GI)
Expected-vs-paid calculation
Expected (contract allowed)
$4,760
Paid (remittance)
$4,020
Variance
$740
Rate basis: 2026 allowed $4,760 (3.2% escalator)
Contract term: Aetna §3.1 Annual rate escalator
Denial / adjustment reason: Paid at prior year rate grid
Ownership & confidence
- Owner
- C. Ford
- Confidence
- 88 / 100
- Claim age
- 34 days
- Recovery action
- Batch-adjust all 2026 claims paid at stale grid; cite §3.1 escalator.
Evidence provenance
- Evidence
- Aetna 835 batch A · line 77
- Linked agreement
- Commercial Payer Participation Agreement
- Linked payer
- Aetna
Recovery workflow
Demo action — resets on reload · not persistedChronology & session activity
- seed2026-06-09 — REV-CLM-3201 surfaced by VERIFY expected-vs-paid rule from the 835/837 batch extract · FY2026 Q3 (Apr–Jun 2026).
- seed2026-06-09 — Contract term matched; expected allowed amount recomputed from loaded rate basis.