Claim CLM-2026501006
$56,086.04
billed
$51,497.11
allowed
$0.00
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Hospital admission (procedure) | 32485007 | $0.00 | $0.00 |
| History AND physical examination (procedure) | 63332003 | $431.40 | $0.00 |
| Initial patient assessment (procedure) | 315639002 | $431.40 | $0.00 |
| Manual wheelchair (physical object) | 228869008 | $0.00 | $0.00 |
Denial risk — 12/99
Scored by the denial-risk model before adjudication. Advisory only — nothing blocks on a score; the factors below cite the adjudication history they came from.
| Factor | Weight |
|---|---|
| High-dollar claim ($56,086.04 billed) — history shows elevated review rates | +0.35 |
| Aetna denial history: 599 of 6897 claims denied (9%) | -0.05 |
| Service 315639002 (Initial patient assessment (procedure)): 16 of 146 historically denied (11%) | +0.03 |