CLM-2026-10244Appeal Needed
Valley Ortho Group
Dr. Ana Ortiz · United Healthcare
CO-50 — Medical necessity
$892.00
12d since denial · Appeal due 2026-05-29 · Urgent
Foundation only. No clearinghouse, ERA/EOB import, or live denial APIs. All data is placeholder from web/src/lib/denial-management/. Onboarding specialists may view when denials relate to setup issues (demo access via persona switcher).
Filters
Practice
Provider
Payer
Denial reason
Status
Priority
Denied from
Denied to
Demo KPIs — no denial tables in CRM yet. Values update when filters change.
Total Denials
8
Denied Amount
$6,801.75
Appeals Due This Week
4
High Priority Denials
6
Denials by Payer
6
Preventable Denials
6
Denials work queue
Primary workspace for billing staff — assign, appeal, and resolve
| Claim # | Practice | Provider | Payer | Denial Code | Denial Reason | Denied Amount | Days | Appeal Due | Status | Assigned | Priority | Actions |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CLM-2026-10244 | Valley Ortho Group | Dr. Ana Ortiz | United Healthcare | CO-50 | Medical necessity | $892.00 | 12 | 2026-05-29 | Appeal Needed | Mike T. | Urgent | |
| CLM-2026-09902 | Valley Ortho Group | Dr. Ana Ortiz | Aetna HMO | CO-29 | Timely filing | $1,540.00 | 28 | 2026-05-26 | New | — | Urgent | |
| CLM-2026-10390 | Lakeside Pediatrics | Dr. Sam Lee | BCBS | CO-16 | Missing documentation | $456.75 | 8 | 2026-06-03 | In Review | Renee B. | High | |
| CLM-2026-10188 | Sunrise Family Care | Dr. Maria Chen | Medicare | CO-4 | Coding error | $320.00 | 45 | — | Appealed | Mike T. | Medium | |
| CLM-2026-10055 | Sunrise Family Care | Dr. Jordan Patel | Humana | CO-18 | Duplicate claim | $210.00 | 60 | — | Resolved | Renee B. | Low | |
| CLM-2026-10401 | Lakeside Pediatrics | Dr. Sam Lee | Medicaid | CO-197 | Authorization required | $178.00 | 4 | 2026-06-07 | New | — | High | |
| CLM-2026-09812 | Sunrise Family Care | Dr. Maria Chen | Aetna PPO | CO-50 | Medical necessity | $2,100.00 | 18 | 2026-05-28 | Appeal Needed | Mike T. | Urgent | |
| CLM-2026-09701 | Valley Ortho Group | Dr. Ana Ortiz | Medicare | CO-16 | Missing documentation | $680.00 | 90 | — | Written Off | Renee B. | Low | |
| CLM-2026-10322 | Sunrise Family Care | Dr. Jordan Patel | BCBS | CO-29 | Timely filing | $425.00 | 6 | 2026-05-30 | In Review | Renee B. | Medium | |
| CLM-2026-10555 | Lakeside Pediatrics | Dr. Sam Lee | United Healthcare | CO-4 | Coding error | $890.00 | 3 | 2026-06-04 | New | Mike T. | High |
High-dollar denials
Open denials at or above $750
- CLM-2026-09812Appeal NeededUrgent
Sunrise Family Care · Aetna PPO · Medical necessity
$2,100.00 · Appeal due 2026-05-28
- CLM-2026-09902NewUrgent
Valley Ortho Group · Aetna HMO · Timely filing
$1,540.00 · Appeal due 2026-05-26
- CLM-2026-10244Appeal NeededUrgent
Valley Ortho Group · United Healthcare · Medical necessity
$892.00 · Appeal due 2026-05-29
- CLM-2026-10555NewHigh
Lakeside Pediatrics · United Healthcare · Coding error
$890.00 · Appeal due 2026-06-04
Appeal deadline queue
Appeals due in the next 14 days
- CLM-2026-09902NewUrgent
Valley Ortho Group · Aetna HMO · Timely filing
$1,540.00 · Appeal due 2026-05-26
- CLM-2026-09812Appeal NeededUrgent
Sunrise Family Care · Aetna PPO · Medical necessity
$2,100.00 · Appeal due 2026-05-28
- CLM-2026-10244Appeal NeededUrgent
Valley Ortho Group · United Healthcare · Medical necessity
$892.00 · Appeal due 2026-05-29
- CLM-2026-10322In ReviewMedium
Sunrise Family Care · BCBS · Timely filing
$425.00 · Appeal due 2026-05-30
- CLM-2026-10390In ReviewHigh
Lakeside Pediatrics · BCBS · Missing documentation
$456.75 · Appeal due 2026-06-03
- CLM-2026-10555NewHigh
Lakeside Pediatrics · United Healthcare · Coding error
$890.00 · Appeal due 2026-06-04
- CLM-2026-10401NewHigh
Lakeside Pediatrics · Medicaid · Authorization required
$178.00 · Appeal due 2026-06-07
Denial reason breakdown
Demo aggregation by reason (filtered set).
- Medical necessity2 · $2,992.00
- Timely filing2 · $1,965.00
- Coding error2 · $1,210.00
- Missing documentation2 · $1,136.75
- Duplicate claim1 · $210.00
- Authorization required1 · $178.00
Payer trend panel
Demo volume by payer — future: rolling 30/90-day analytics.
| Payer | Count | Amount | Trend |
|---|---|---|---|
| United Healthcare | 2 | $1,782.00 | ↑ |
| BCBS | 2 | $881.75 | → |
| Medicare | 2 | $1,000.00 | ↑ |
| Aetna HMO | 1 | $1,540.00 | ↓ |
| Humana | 1 | $210.00 | ↓ |
| Medicaid | 1 | $178.00 | → |
| Aetna PPO | 1 | $2,100.00 | ↑ |
Root cause analysis
Demo categories — future: ML + rules engine on CARC/RARC patterns.
Front-end eligibility4
Verify auth before DOS
Coding & modifiers3
Coder QA on high-volume CPTs
Documentation gaps5
Operative note requests
Timely filing2
Batch submit SLA
Payer policy change1
Monitor payer bulletins