Fictional TRH demo data — no PHI
Harsight VERIFY
← Spend exceptions
TRH demo record · fictionalDenial variancePayer denial variancehigh severitymedium confidence

Medical-necessity denial pattern vs. Attachment 3 policy.

EX-2020 · opened 2026-06-10 (39d) · Aetna

$64,200
Recoverable (underpaid)

Three-way match

Recoverable (underpaid)
Contract term
$64,200
Reimbursable per contract
Denial report AE Jun
Invoice / claim line
$0
Denied / not paid
Denial report AE Jun
VERIFY expected
$64,200
Expected reimbursement
VERIFY denial review
Exact variance$64,200

Contractually reimbursable 64200 was denied → 64200 recoverable on appeal.

Baseline figures are illustrative demo values; the variance is the exact recoverable/avoidable amount VERIFY flagged.

Evidence & source

EvidenceDenial report AE Jun
CategoryPayer denial variance
Owner (record)C. Ford
Status (record)In review
Linked agreementCommercial Payer Participation Agreement (AGR-AE-001)
Download evidence (CSV)Download contract (PDF)

Chronology

  1. Flagged by VERIFY
    Denial variance detected against contract evidence: Denial report AE Jun.
    2026-06-10
    done
  2. Assigned for triage
    Routed to C. Ford for review.
    2026-06-10
    done
  3. Current status: In review
    Under active reconciliation with the counterparty.
    2026-06-10
    current
  4. Next: recover / dispute
    Request credit, open a dispute, or accept as expected — demo actions below.
    —
    pending

Resolution workflow

Open
Interactive demo — actions are in-memory only and reset on reload; nothing is written to any store.
of $64,200 flagged

Notes

0

No notes yet.

Other exceptions · Aetna

2
  • Underpayment
    Radiology fee-schedule variance on advanced imaging.
    $41,500
  • SLA breach
    Adjudication timing exceeding 21-day window.
    $16,000