← Revenue worklist
REV-CLM-3202
DenialAssignedFictional TRH demo — synthetic claim id · no PHIAetna · Emergency · APC 5023 (Level 3 ED)
Expected-vs-paid calculation
Expected (contract allowed)
$980
Paid (remittance)
$0
Variance
$980
Rate basis: Level 3 allowed $980
Contract term: Aetna §5 Clean-claim standard
Denial / adjustment reason: CO-16 missing/invalid modifier
Ownership & confidence
- Owner
- M. Duran
- Confidence
- 69 / 100
- Claim age
- 19 days
- Recovery action
- Correct modifier and resubmit within clean-claim window.
Evidence provenance
- Evidence
- Aetna 835 denial batch B · line 33
- Linked agreement
- Commercial Payer Participation Agreement
- Linked payer
- Aetna
Recovery workflow
Demo action — resets on reload · not persistedChronology & session activity
- seed2026-06-24 — REV-CLM-3202 surfaced by VERIFY expected-vs-paid rule from the 835/837 batch extract · FY2026 Q3 (Apr–Jun 2026).
- seed2026-06-24 — Contract term matched; expected allowed amount recomputed from loaded rate basis.