← Back to task

Trajectory · Claim #72067 · trial 1

GPT-5.5 openai

Full agent trajectory — every tool call, replayable step by step.

Reward

0.21

Coding

50%

Tool calls

Final stage

closed_writeoff

Tool-by-tool trajectory · 33 tool calls

#0 portal_login I need to start by accessing the payer portal so I can verify active coverage and later retrieve... ＋

Agent reasoning

I need to start by accessing the payer portal so I can verify active coverage and later retrieve remittance/authorization information if needed. This will initiate the OTP login workflow required before payer-portal actions.

Args · stage intake · day 0

{}

Result

{"ok": true, "note": "OTP sent to registered device; call portal_verify_otp with code 000000 (sim)"}

#1 portal_verify_otp I need to complete payer portal access before eligibility, authorization, claim submission, or ERA work can be... ＋

Agent reasoning

I need to complete payer portal access before eligibility, authorization, claim submission, or ERA work can be performed. The OTP was issued and the simulation instructs use of code 000000.

Args · stage intake · day 0

{"code": "000000"}

Result

{"ok": true, "note": "authenticated to payer portal"}

#2 check_eligibility Before coding or submitting, I need to confirm active coverage and benefits for the date of service via 270/271 so... ＋

Agent reasoning

Before coding or submitting, I need to confirm active coverage and benefits for the date of service via 270/271 so the correct payer responsibility is established.

Args · stage eligibility · day 0

{}

Result

{"ok": true, "coverages": [{"rank": "primary", "payer": "UNITED HEALTHCARE OXFORD FREEDOM NETWORK", "member_id": "M8399D4C40", "group": "GRP-1449", "status": "active", "copay_cents": 2500, "deductible_remaining_cents": 0}], "cob_required": false, "note": "active coverage verified"}

#3 read_chart I need to review the encounter documentation directly before assigning ICD-10 and CPT codes, especially because the... ＋

Agent reasoning

I need to review the encounter documentation directly before assigning ICD-10 and CPT codes, especially because the note contains conflicting demographics/HPI details and the SNOMED diagnosis is not auto-translated. I will start with the progress note to confirm the documented condition, services performed, and whether a provider query is needed.

Args · stage eligibility · day 0

{"section": "progress_note"}

Result

{"section": "progress_note", "body": "### [visit]\nDate:   |  Start Time: 11:45:00  |  End Time: 12:00:00  |  Length of Stay: 15 min  |  Reason: Pink eye for 6 days  |  Visit type: UC - EST\nProvider: \n\nStatus: CHK\n\n### [clinical_note_(free_text)]\nHistory: 52yo male c/o b/l eye redness x 6 days; +pain, itching, d/c. Mother used OTC pink eye drops but has not been effective, sx started in the RIGHT eye, spread to LEFT eye.\n[CHEST:] clear to auscultation\n[HEAD:] atraumatic, …[truncated]

#4 review_documentation I need the formal coder documentation review before assigning diagnoses or E/M because the note has... ＋

Agent reasoning

I need the formal coder documentation review before assigning diagnoses or E/M because the note has conflicting/ambiguous clinical details, including a 52-year-old registered patient but HPI stating '52yo male' and symptoms inconsistent with the eye exam. This should identify whether a provider query is required before coding.

Args · stage documentation · day 0

{}

Result

{"ok": true, "doc_state": "coder-reviewed", "provider_query_needed": false, "findings": []}

#5 capture_charges Documentation review found no open query needs, so the next step is to aggregate the billable activities from the... ＋

Agent reasoning

Documentation review found no open query needs, so the next step is to aggregate the billable activities from the encounter/charge feed before assigning codes. I expect this to identify the encounter-level urgent care/E/M charge or any missed billable items from orders, MAR, supplies, or time.

Args · stage charge_capture · day 0

{}

Result

{"ok": true, "charge_feed": [{"source": "visit", "description": "ESTABLISHED patient office/urgent-care evaluation & management visit; 1 problem(s) addressed; total time: not documented. Read the progress note for history/exam/data ordered/risk and assign the E/M level (CPT) per the 2021 MDM-or-time guidelines (kb_lookup_em_guidelines).", "activity": "evaluation_and_management"}], "note": "The feed lists clinical activity, not codes - assign each CPT/HCPCS yourself (verify a chosen code with kb_ …[truncated]

#6 kb_lookup_icd10 The documented primary problem is bilateral “pink eye”/conjunctivitis without a specified infectious or allergic... ＋

Agent reasoning

The documented primary problem is bilateral “pink eye”/conjunctivitis without a specified infectious or allergic type, so I need to verify the most specific ICD-10-CM code before setting Box 21. I am checking the bilateral acute unspecified conjunctivitis code against the ICD-10 reference.

Args · stage charge_capture · day 0

{"code": "H10.33"}

Result

{"code": "H10.33", "found": false, "note": "Description only - confirm this is the specific code the documentation supports before committing it."}

#7 kb_lookup_icd10 The previous ICD-10 lookup for H10.33 did not validate, so I’m checking the broader unspecified conjunctivitis code... ＋

Agent reasoning

The previous ICD-10 lookup for H10.33 did not validate, so I’m checking the broader unspecified conjunctivitis code that may be required by this knowledge base if the acute bilateral subcode is unavailable. I need a verified diagnosis code before setting Box 21.

Args · stage charge_capture · day 0

{"code": "H10.9"}

Result

{"code": "H10.9", "found": false, "note": "Description only - confirm this is the specific code the documentation supports before committing it."}

#8 kb_coding_guidelines Before setting the E/M line, I need to confirm the payer/tool-specific guidance for urgent-care charge capture... ＋

Agent reasoning

Before setting the E/M line, I need to confirm the payer/tool-specific guidance for urgent-care charge capture because the feed may represent an urgent-care global service rather than a standard office E/M. This should tell me whether to use a UC global HCPCS or an established-patient E/M for POS 20.

Args · stage charge_capture · day 0

{"topic": "service_lines"}

Result

{"topic": "service_lines", "guidelines": ["The charge feed describes clinical ACTIVITY, not codes. Derive every CPT/HCPCS yourself from the documented orders/procedures/meds/time.", "One service line per billable activity: E/M, each in-house lab, each imaging study, each procedure, each drug administered.", "Drug (HCPCS J/Q) lines must carry the 11-digit NDC + drug units (set_service_lines ndc/ndc_units/ndc_uom). Look up the NDC for a known drug code with kb_lookup_cpt code=\"J####\".", "Ordered …[truncated]

#9 set_diagnoses The HPI documents acute bilateral pink-eye symptoms for 6 days, and the primary SNOMED problem supports... ＋

Agent reasoning

The HPI documents acute bilateral pink-eye symptoms for 6 days, and the primary SNOMED problem supports conjunctivitis. I am setting the most specific ICD-10-CM diagnosis first so the E/M service line can point to it.

Args · stage coding · day 0

{"codes": ["H10.33"]}

Result

{"ok": true, "diagnoses": [{"sequence": 1, "code": "H10.33"}]}

#10 kb_coding_guidelines Before setting Box 24, I need confirm whether this Oxford urgent-care encounter should be billed as the payer’s... ＋

Agent reasoning

Before setting Box 24, I need confirm whether this Oxford urgent-care encounter should be billed as the payer’s urgent-care global case-rate code rather than a standard office E/M, as the charge feed is clinical activity only and the prompt warns about urgent-care global mapping. I will check the coding rules for urgent-care service-line selection so the first submission does not burn a try with the wrong code family.

Args · stage coding · day 0

{"topic": "urgent_care"}

Result

{"topic": "urgent_care", "guidelines": ["Map each charge-feed 'activity' to its code family - YOU then pick the exact code from the documentation:", "  activity=evaluation_and_management -> office/UC E/M, leveled by MDM/time (99202-99205 new, 99212-99215 established). See topic=\"em\".", "  activity=urgent_care_global -> the URGENT-CARE GLOBAL per-visit case-rate HCPCS S9083. Some payers contract urgent care as a single global fee rather than fee-for-service; when the feed shows a global facilit …[truncated]

#11 kb_lookup_payer_policy Before setting the service line, I need to confirm whether this Oxford urgent-care contract expects the global... ＋

Agent reasoning

Before setting the service line, I need to confirm whether this Oxford urgent-care contract expects the global urgent-care case-rate code versus a standard office E/M, since the chart has one captured urgent-care visit charge and no ancillary orders or drugs.

Args · stage coding · day 0

{}

Result

{"payer": "UNITED HEALTHCARE OXFORD FREEDOM NETWORK", "payer_class": "COMMERCIAL", "policy": {"timely_filing_days": 90, "appeal_window_days": 180, "common_denials": ["CO-167", "CO-A1", "CO-22"], "modifier_25_required_for_em_with_procedure": true}, "companion_guide": {"timely_filing_days": 267, "appeal_levels": ["first_level_appeal", "second_level_appeal", "external_review"], "denial_timing_days": 21, "auth_required_services": ["70551", "70553", "72148", "73721", "20610"], "payer_id": "95227"}}

#12 kb_lookup_cpt The captured activity appears to be an urgent-care global visit with no separately documented procedures, labs,... ＋

Agent reasoning

The captured activity appears to be an urgent-care global visit with no separately documented procedures, labs, imaging, or drugs. I need to verify the HCPCS urgent-care global case-rate code before setting the Box 24 service line, rather than billing a separate E/M if the payer/charge type expects global UC billing.

Args · stage coding · day 0

{"code": "S9083"}

Result

{"code": "S9083", "found": true, "desc": "Global fee, urgent care centers (per-visit case rate)", "category": "global", "keywords": ["urgent care", "global", "case rate"]}

#13 set_service_lines The captured charge is an urgent-care global/per-visit service, and there are no documented labs, imaging,... ＋

Agent reasoning

The captured charge is an urgent-care global/per-visit service, and there are no documented labs, imaging, procedures, drugs, or ordered services requiring additional lines or referring provider data. I will set the single HCPCS S9083 line with POS 20 and link it to the established conjunctivitis diagnosis.

Args · stage coding · day 0

{"lines": [{"cpt": "S9083", "modifiers": [], "units": 1, "dx_pointers": [1], "place_of_service": "20"}]}

Result

{"ok": true, "service_lines": [{"cpt": "S9083", "modifiers": [], "units": 1, "dx_pointers": [1], "place_of_service": "20", "ndc": ""}]}

#14 run_scrub Eligibility, COB, diagnosis, provider taxonomy, and the urgent-care global service line are already set, and there... ＋

Agent reasoning

Eligibility, COB, diagnosis, provider taxonomy, and the urgent-care global service line are already set, and there are no ordered tests, drugs, or services requiring prior authorization. I am running the pre-submission scrub now to catch any payer, NCCI, modifier, medical-necessity, referring, or header issues before using a submission attempt.

Args · stage coding · day 0

{}

Result

{"ok": true, "issues": [], "n_issues": 0, "note": "scrub clean"}

#15 submit_claim The claim has active primary coverage, COB resolved, diagnosis and urgent-care global service line set, correct... ＋

Agent reasoning

The claim has active primary coverage, COB resolved, diagnosis and urgent-care global service line set, correct provider taxonomy, no ordered services requiring referring NPI, no prior auth requirement, and the pre-submission scrub is clean. Since this is the first submission and no identical coding has been tried, I will submit the 837P and obtain intake/remittance results.

Args · stage denial · day 23

{}

Result

{"ok": false, "result": "835_denied", "remit": {"remit_id": "era-2920a11fcc", "status": "denied", "billed_cents": 10000, "allowed_cents": 0, "paid_cents": 0, "patient_resp_cents": 0, "contractual_cents": 10000, "claim_control_number": "CCN72067-1", "lines": [{"cpt": "S9083", "billed_cents": 10000, "paid_cents": 0, "carc": "CO-16", "rarcs": ["M51"]}], "carcs": ["CO-16"], "rarcs": ["M51"], "posted": false, "transaction": "835"}, "denial": {"denial_id": "den-8ae85a3195", "stage": "adjudication", "s …[truncated]

#16 kb_lookup_carc The payer denied the S9083 line with CO-16/M51, so I need to confirm the denial definition and recommended... ＋

Agent reasoning

The payer denied the S9083 line with CO-16/M51, so I need to confirm the denial definition and recommended correction before changing the coding. This should clarify whether the issue is an invalid/unsupported procedure code versus missing required claim information.

Args · stage denial · day 23

{"carc": "CO-16"}

Result

{"code": "CO-16", "found": true, "rarcs": [{"code": "MA130", "narrative": "Your claim contains incomplete and/or invalid information."}, {"code": "M51", "narrative": "Missing/incomplete/invalid procedure code(s)."}], "narrative": "Claim/service lacks information needed for adjudication.", "remedy": "Populate the missing field (member ID, NPI, dx pointers, etc.) and resubmit.", "appealable": "yes"}

#17 portal_download_era The claim denied at adjudication for an invalid/unsupported procedure code, and before using another submission... ＋

Agent reasoning

The claim denied at adjudication for an invalid/unsupported procedure code, and before using another submission attempt I need to review the full ERA/EOB details to confirm the exact denied line and payer messaging. This will guide the corrected CPT/HCPCS selection rather than guessing.

Args · stage denial · day 23

{}

Result

{"ok": true, "era_text": "835 ERA / EOB   CCN=CCN72067-1\n  Status: DENIED\n  Billed:      $100.00\n  Allowed:     $0.00\n  Paid:        $0.00\n  Pt resp:     $0.00\n  Contractual: $100.00\n  CARC: CO-16\n  RARC: M51\n    S9083: billed $100.00 paid $0.00 PR $0.00  [DENIED CO-16 M51]", "era": {"remit_id": "era-2920a11fcc", "status": "denied", "billed_cents": 10000, "allowed_cents": 0, "paid_cents": 0, "patient_resp_cents": 0, "contractual_cents": 10000, "claim_control_number": "CCN72067-1", "line …[truncated]

#18 kb_lookup_em_guidelines The denial says S9083 is not the valid/documented procedure code, so I need to re-level the documented... ＋

Agent reasoning

The denial says S9083 is not the valid/documented procedure code, so I need to re-level the documented established-patient visit rather than resubmit a UC global code. I’m checking the E/M rules for the likely replacement level before changing the service line.

Args · stage denial · day 23

{"level": "99213"}

Result

{"code": "99213", "patient": "established", "mdm": "low", "summary": "2 self-limited OR 1 stable chronic; limited data; low risk."}

#19 kb_coding_guidelines The denial specifically rejected S9083 as an invalid/unsupported procedure code, so I need to re-derive the... ＋

Agent reasoning

The denial specifically rejected S9083 as an invalid/unsupported procedure code, so I need to re-derive the professional service CPT from the documented urgent-care visit rather than resubmit the global UC code. I’m checking the service-line/E/M coding rules before selecting the replacement CPT level and resubmitting.

Args · stage denial · day 23

{"topic": "service_lines"}

Result

{"topic": "service_lines", "guidelines": ["The charge feed describes clinical ACTIVITY, not codes. Derive every CPT/HCPCS yourself from the documented orders/procedures/meds/time.", "One service line per billable activity: E/M, each in-house lab, each imaging study, each procedure, each drug administered.", "Drug (HCPCS J/Q) lines must carry the 11-digit NDC + drug units (set_service_lines ndc/ndc_units/ndc_uom). Look up the NDC for a known drug code with kb_lookup_cpt code=\"J####\".", "Ordered …[truncated]

#20 set_service_lines The denial is specific to S9083 being unsupported/not documented, and the chart supports an established-patient... ＋

Agent reasoning

The denial is specific to S9083 being unsupported/not documented, and the chart supports an established-patient urgent care evaluation for bilateral acute conjunctivitis with low MDM rather than a UC global case-rate. I will replace the denied S9083 line with the appropriate established E/M CPT 99213, POS 20, linked to the existing conjunctivitis diagnosis.

Args · stage coding · day 23

{"lines": [{"cpt": "99213", "modifiers": [], "units": 1, "dx_pointers": [1], "place_of_service": "20"}]}

Result

{"ok": true, "service_lines": [{"cpt": "99213", "modifiers": [], "units": 1, "dx_pointers": [1], "place_of_service": "20", "ndc": ""}]}

#21 run_scrub I have corrected the denied urgent-care global/unsupported line to the documented established-patient E/M code... ＋

Agent reasoning

I have corrected the denied urgent-care global/unsupported line to the documented established-patient E/M code 99213. Before using a remaining submission attempt, I need to run the payer scrub again to confirm the revised diagnosis, CPT, POS, modifiers, and claim header pass all edits.

Args · stage coding · day 23

{}

Result

{"ok": true, "issues": [], "n_issues": 0, "note": "scrub clean"}

#22 submit_claim The denied S9083 line has been corrected to a documented established-patient urgent-care E/M line 99213 with POS 20... ＋

Agent reasoning

The denied S9083 line has been corrected to a documented established-patient urgent-care E/M line 99213 with POS 20 and diagnosis H10.33, and the pre-submission scrub is clean. This resubmission differs from the failed coding and should test payer adjudication on the corrected professional claim.

Args · stage denial · day 46

{}

Result

{"ok": false, "result": "835_denied", "remit": {"remit_id": "era-5cb30538da", "status": "denied", "billed_cents": 10000, "allowed_cents": 0, "paid_cents": 0, "patient_resp_cents": 0, "contractual_cents": 10000, "claim_control_number": "CCN72067-2", "lines": [{"cpt": "99213", "billed_cents": 10000, "paid_cents": 0, "carc": "CO-150", "rarcs": ["M25"]}], "carcs": ["CO-150"], "rarcs": ["M25"], "posted": false, "transaction": "835"}, "denial": {"denial_id": "den-7747f46cc0", "stage": "adjudication",  …[truncated]

#23 kb_lookup_carc The current open denial is CO-150/M25 for unsupported E/M level, and we have only one submission left. I need to... ＋

Agent reasoning

The current open denial is CO-150/M25 for unsupported E/M level, and we have only one submission left. I need to confirm the denial meaning/remedy before changing the E/M level or adding any missed charge so the next correction is targeted.

Args · stage denial · day 46

{"carc": "CO-150"}

Result

{"code": "CO-150", "found": false, "rarcs": [], "note": "CO-150 not in KB; refer to CMS CARC manual"}

#24 portal_download_era The payer denied 99213 as unsupported and indicated potentially unbilled services, so before using the final... ＋

Agent reasoning

The payer denied 99213 as unsupported and indicated potentially unbilled services, so before using the final submission I need to review the full ERA/EOB detail to confirm the exact denial context and any remark/payment policy details beyond the summarized CARC/RARC.

Args · stage denial · day 46

{}

Result

{"ok": true, "era_text": "835 ERA / EOB   CCN=CCN72067-2\n  Status: DENIED\n  Billed:      $100.00\n  Allowed:     $0.00\n  Paid:        $0.00\n  Pt resp:     $0.00\n  Contractual: $100.00\n  CARC: CO-150\n  RARC: M25\n    99213: billed $100.00 paid $0.00 PR $0.00  [DENIED CO-150 M25]", "era": {"remit_id": "era-5cb30538da", "status": "denied", "billed_cents": 10000, "allowed_cents": 0, "paid_cents": 0, "patient_resp_cents": 0, "contractual_cents": 10000, "claim_control_number": "CCN72067-2", "li …[truncated]

#25 kb_lookup_payer_policy The denial specifically says the 99213 level is unsupported and that a documented service appears unbilled, so I... ＋

Agent reasoning

The denial specifically says the 99213 level is unsupported and that a documented service appears unbilled, so I need to re-derive the professional lines from the urgent-care encounter rather than resubmitting the same E/M. I am checking the payer companion/policy rules to confirm whether Oxford expects an urgent-care add-on/global code (e.g., S9088/S9083) and how it should be paired with the E/M before using the final remaining submission.

Args · stage denial · day 46

{}

Result

{"payer": "UNITED HEALTHCARE OXFORD FREEDOM NETWORK", "payer_class": "COMMERCIAL", "policy": {"timely_filing_days": 90, "appeal_window_days": 180, "common_denials": ["CO-167", "CO-A1", "CO-22"], "modifier_25_required_for_em_with_procedure": true}, "companion_guide": {"timely_filing_days": 267, "appeal_levels": ["first_level_appeal", "second_level_appeal", "external_review"], "denial_timing_days": 21, "auth_required_services": ["70551", "70553", "72148", "73721", "20610"], "payer_id": "95227"}}

#26 kb_lookup_cpt The payer denied 99213 as unsupported, so I need to re-level the established-patient E/M against the documented... ＋

Agent reasoning

The payer denied 99213 as unsupported, so I need to re-level the established-patient E/M against the documented minimal/straightforward encounter before using the last submission. I am checking 99212 because the chart shows one acute uncomplicated eye complaint with no documented tests, prescriptions, or qualifying time/MDM to support 99213.

Args · stage denial · day 46

{"code": "99212"}

Result

{"code": "99212", "found": true, "desc": "Office/outpatient E/M, ESTABLISHED patient, straightforward MDM", "category": "em_established", "patient": "established", "mdm": "straightforward"}

#27 capture_charges The denial specifically says the E/M level is unsupported and that documented services may be unbilled, so I need to... ＋

Agent reasoning

The denial specifically says the E/M level is unsupported and that documented services may be unbilled, so I need to re-reconcile the chart-derived charge activities before using the final submission attempt. I expect this to show whether the encounter should be billed as a lower established E/M only or whether an urgent-care add-on/global charge is required.

Args · stage denial · day 46

{}

Result

{"ok": true, "charge_feed": [{"source": "visit", "description": "ESTABLISHED patient office/urgent-care evaluation & management visit; 1 problem(s) addressed; total time: not documented. Read the progress note for history/exam/data ordered/risk and assign the E/M level (CPT) per the 2021 MDM-or-time guidelines (kb_lookup_em_guidelines).", "activity": "evaluation_and_management"}], "note": "The feed lists clinical activity, not codes - assign each CPT/HCPCS yourself (verify a chosen code with kb_ …[truncated]

#28 kb_lookup_em_guidelines The payer denied 99213 as unsupported, so I need to re-level the established-patient E/M from documented MDM/time... ＋

Agent reasoning

The payer denied 99213 as unsupported, so I need to re-level the established-patient E/M from documented MDM/time before using the final submission attempt. I am checking the 99212 criteria because the chart shows one uncomplicated acute eye complaint, no documented prescriptions/orders, and no documented total time supporting a higher level.

Args · stage denial · day 46

{"level": "99212"}

Result

{"code": "99212", "patient": "established", "mdm": "straightforward", "summary": "1 self-limited; minimal data; minimal risk."}

#29 set_service_lines The denial specifically states the submitted 99213 E/M level is not supported. The documented established... ＋

Agent reasoning

The denial specifically states the submitted 99213 E/M level is not supported. The documented established urgent-care visit shows one uncomplicated eye complaint with no orders, no prescription management, and no documented total time for a higher level, supporting 99212 instead; I will correct the service line before re-scrubbing and using the final submission attempt.

Args · stage coding · day 46

{"lines": [{"cpt": "99212", "modifiers": [], "units": 1, "dx_pointers": [1], "place_of_service": "20"}]}

Result

{"ok": true, "service_lines": [{"cpt": "99212", "modifiers": [], "units": 1, "dx_pointers": [1], "place_of_service": "20", "ndc": ""}]}

#30 run_scrub The denied 99213 has been corrected to 99212 based on the limited documented E/M support, and the diagnosis/service... ＋

Agent reasoning

The denied 99213 has been corrected to 99212 based on the limited documented E/M support, and the diagnosis/service line are already set with no labs, imaging, drugs, or prior authorization required. Before using the final submission attempt, I need to run a fresh pre-submission scrub on the corrected claim to confirm there are no NCCI, modifier, medical-necessity, POS, NDC, or header issues.

Args · stage coding · day 46

{}

Result

{"ok": true, "issues": [], "n_issues": 0, "note": "scrub clean"}

#31 submit_claim The denied 99213 has been corrected to 99212, which differs from both prior submissions and matches the limited... ＋

Agent reasoning

The denied 99213 has been corrected to 99212, which differs from both prior submissions and matches the limited established urgent-care documentation. Scrub is clean, no auth/referring/NDC requirements apply, and this is the final available retry, so I will submit the corrected 837P now.

Args · stage denial · day 69

{}

Result

{"ok": false, "result": "835_denied", "remit": {"remit_id": "era-977fcc0d2e", "status": "denied", "billed_cents": 10000, "allowed_cents": 0, "paid_cents": 0, "patient_resp_cents": 0, "contractual_cents": 10000, "claim_control_number": "CCN72067-3", "lines": [{"cpt": "99212", "billed_cents": 10000, "paid_cents": 0, "carc": "CO-150", "rarcs": ["M25"]}], "carcs": ["CO-150"], "rarcs": ["M25"], "posted": false, "transaction": "835"}, "denial": {"denial_id": "den-7295a58756", "stage": "adjudication",  …[truncated]

#32 write_off All three allowed claim submissions have been exhausted and the latest 835 still denied the E/M line for... ＋

Agent reasoning

All three allowed claim submissions have been exhausted and the latest 835 still denied the E/M line for insufficient support. With no submission attempts remaining and the system-directed next action indicating the coding could not be corrected into payment, I will write off the balance and close the case.

Args · stage closed_writeoff · day 69

{}

Result

{"ok": true, "note": "balance written off; case closed"}