predictions_current_claims.csv

claim_id,denial_probability,predicted_denial,risk_tier,top_risk_factors,explanation
CCLM-00372,0.9259783429334763,1,High,authorization required but not on file; documentation appears incomplete or missing; expected payment is low relative to billed amount,"This claim has a 93% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and expected payment is low relative to billed amount. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00087,0.9243954359067151,1,High,documentation appears incomplete or missing; patient eligibility is not verified; claim was submitted more than 30 days after service,"This claim has a 92% estimated denial probability, mainly due to documentation appears incomplete or missing, patient eligibility is not verified, and claim was submitted more than 30 days after service. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00082,0.9127172791148551,1,High,documentation appears incomplete or missing; patient eligibility is not verified; referral required but not present,"This claim has a 91% estimated denial probability, mainly due to documentation appears incomplete or missing, patient eligibility is not verified, and referral required but not present. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00177,0.904631159166965,1,High,authorization required but not on file; documentation appears incomplete or missing; claim was submitted more than 30 days after service,"This claim has a 90% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and claim was submitted more than 30 days after service. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00049,0.8983810666510537,1,High,authorization required but not on file; documentation appears incomplete or missing; referral required but not present,"This claim has a 90% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and referral required but not present. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00285,0.895158295782529,1,High,authorization required but not on file; documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity,"This claim has a 90% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00213,0.8859808313496014,1,High,authorization required but not on file; claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity,"This claim has a 89% estimated denial probability, mainly due to authorization required but not on file, claim was submitted more than 30 days after service, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00136,0.8821875584814173,1,High,documentation appears incomplete or missing; referral required but not present; claim has relatively high procedure/diagnosis complexity,"This claim has a 88% estimated denial probability, mainly due to documentation appears incomplete or missing, referral required but not present, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00259,0.8784011485606915,1,High,authorization required but not on file; referral required but not present; claim has relatively high procedure/diagnosis complexity,"This claim has a 88% estimated denial probability, mainly due to authorization required but not on file, referral required but not present, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00352,0.8717116044604861,1,High,authorization required but not on file; documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity,"This claim has a 87% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00023,0.867095544110137,1,High,authorization required but not on file; documentation appears incomplete or missing; claim was submitted more than 30 days after service,"This claim has a 87% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and claim was submitted more than 30 days after service. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00344,0.8644641170801772,1,High,authorization required but not on file; documentation appears incomplete or missing,"This claim has a 86% estimated denial probability, mainly due to authorization required but not on file, and documentation appears incomplete or missing. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00163,0.8607325700313019,1,High,authorization required but not on file; referral required but not present; provider is out of network for the payer,"This claim has a 86% estimated denial probability, mainly due to authorization required but not on file, referral required but not present, and provider is out of network for the payer. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00416,0.853348501262859,1,High,authorization required but not on file; patient eligibility is not verified; claim has a relatively high billed amount,"This claim has a 85% estimated denial probability, mainly due to authorization required but not on file, patient eligibility is not verified, and claim has a relatively high billed amount. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00383,0.8511045227554773,1,High,patient eligibility is not verified; referral required but not present; claim was submitted more than 30 days after service,"This claim has a 85% estimated denial probability, mainly due to patient eligibility is not verified, referral required but not present, and claim was submitted more than 30 days after service. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00013,0.8495872061016655,1,High,authorization required but not on file; patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity,"This claim has a 85% estimated denial probability, mainly due to authorization required but not on file, patient eligibility is not verified, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00062,0.8494413084415194,1,High,authorization required but not on file; patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity,"This claim has a 85% estimated denial probability, mainly due to authorization required but not on file, patient eligibility is not verified, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00446,0.8493824942639661,1,High,documentation appears incomplete or missing; patient eligibility is not verified; provider is out of network for the payer,"This claim has a 85% estimated denial probability, mainly due to documentation appears incomplete or missing, patient eligibility is not verified, and provider is out of network for the payer. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00028,0.8371414333461131,1,High,documentation appears incomplete or missing; patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity,"This claim has a 84% estimated denial probability, mainly due to documentation appears incomplete or missing, patient eligibility is not verified, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00279,0.8330625284706623,1,High,documentation appears incomplete or missing; claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity,"This claim has a 83% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 30 days after service, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00135,0.8314541463280664,1,High,documentation appears incomplete or missing; patient eligibility is not verified; claim was submitted more than 30 days after service,"This claim has a 83% estimated denial probability, mainly due to documentation appears incomplete or missing, patient eligibility is not verified, and claim was submitted more than 30 days after service. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00459,0.8300623715265191,1,High,authorization required but not on file; patient eligibility is not verified; provider is out of network for the payer,"This claim has a 83% estimated denial probability, mainly due to authorization required but not on file, patient eligibility is not verified, and provider is out of network for the payer. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00280,0.810835686014246,1,High,documentation appears incomplete or missing; patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity,"This claim has a 81% estimated denial probability, mainly due to documentation appears incomplete or missing, patient eligibility is not verified, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00470,0.8059844342685762,1,High,authorization required but not on file; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 81% estimated denial probability, mainly due to authorization required but not on file, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00476,0.8052809605063775,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 81% estimated denial probability, mainly due to documentation appears incomplete or missing, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00134,0.7978736910228733,1,High,authorization required but not on file; documentation appears incomplete or missing; referral required but not present,"This claim has a 80% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and referral required but not present. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00407,0.7925958699598245,1,High,authorization required but not on file; documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity,"This claim has a 79% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00170,0.7907671254536311,1,High,documentation appears incomplete or missing; patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity,"This claim has a 79% estimated denial probability, mainly due to documentation appears incomplete or missing, patient eligibility is not verified, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00099,0.7860502164947848,1,High,authorization required but not on file; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 79% estimated denial probability, mainly due to authorization required but not on file, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00176,0.784031168607233,1,High,authorization required but not on file; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 78% estimated denial probability, mainly due to authorization required but not on file, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00063,0.7822637765424036,1,High,patient eligibility is not verified; claim was submitted more than 30 days after service; provider is out of network for the payer,"This claim has a 78% estimated denial probability, mainly due to patient eligibility is not verified, claim was submitted more than 30 days after service, and provider is out of network for the payer. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00147,0.7812408694450838,1,High,authorization required but not on file; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 78% estimated denial probability, mainly due to authorization required but not on file, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00307,0.77700897752982,1,High,documentation appears incomplete or missing; claim was submitted more than 30 days after service; claim has a relatively high billed amount,"This claim has a 78% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 30 days after service, and claim has a relatively high billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00221,0.7710911565290912,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 77% estimated denial probability, mainly due to documentation appears incomplete or missing, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00481,0.7710354387408249,1,High,authorization required but not on file; claim was submitted more than 45 days after service; claim was submitted more than 30 days after service,"This claim has a 77% estimated denial probability, mainly due to authorization required but not on file, claim was submitted more than 45 days after service, and claim was submitted more than 30 days after service. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00386,0.7700262024139712,1,High,documentation appears incomplete or missing; claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity,"This claim has a 77% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 30 days after service, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00380,0.7533651866980706,1,High,documentation appears incomplete or missing; claim was submitted more than 45 days after service; claim was submitted more than 30 days after service,"This claim has a 75% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 45 days after service, and claim was submitted more than 30 days after service. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00477,0.7501310848313711,1,High,authorization required but not on file; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 75% estimated denial probability, mainly due to authorization required but not on file, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00179,0.7481717704388938,1,High,authorization required but not on file; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 75% estimated denial probability, mainly due to authorization required but not on file, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00125,0.7426663510650674,1,High,documentation appears incomplete or missing; claim was submitted more than 30 days after service; claim has a relatively high billed amount,"This claim has a 74% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 30 days after service, and claim has a relatively high billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00370,0.7425228661734434,1,High,patient eligibility is not verified; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 74% estimated denial probability, mainly due to patient eligibility is not verified, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00290,0.7408896501687954,1,High,authorization required but not on file; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 74% estimated denial probability, mainly due to authorization required but not on file, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00272,0.7313732683300148,1,High,patient eligibility is not verified; claim was submitted more than 30 days after service; claim has a relatively high billed amount,"This claim has a 73% estimated denial probability, mainly due to patient eligibility is not verified, claim was submitted more than 30 days after service, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00165,0.7258915770392356,1,High,authorization required but not on file; provider is out of network for the payer,"This claim has a 73% estimated denial probability, mainly due to authorization required but not on file, and provider is out of network for the payer. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00214,0.7207131886823795,1,High,patient eligibility is not verified; claim was submitted more than 30 days after service; provider is out of network for the payer,"This claim has a 72% estimated denial probability, mainly due to patient eligibility is not verified, claim was submitted more than 30 days after service, and provider is out of network for the payer. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00463,0.7164815630876982,1,High,claim was submitted more than 45 days after service; claim was submitted more than 30 days after service; claim has a relatively high billed amount,"This claim has a 72% estimated denial probability, mainly due to claim was submitted more than 45 days after service, claim was submitted more than 30 days after service, and claim has a relatively high billed amount. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00051,0.714095940444213,1,High,authorization required but not on file; documentation appears incomplete or missing; provider is out of network for the payer,"This claim has a 71% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and provider is out of network for the payer. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00152,0.7114755088702274,1,High,documentation appears incomplete or missing; claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity,"This claim has a 71% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 30 days after service, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00500,0.7094175338780354,1,High,documentation appears incomplete or missing; claim was submitted more than 45 days after service; claim was submitted more than 30 days after service,"This claim has a 71% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 45 days after service, and claim was submitted more than 30 days after service. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00037,0.7086550578429736,1,High,authorization required but not on file; patient eligibility is not verified,"This claim has a 71% estimated denial probability, mainly due to authorization required but not on file, and patient eligibility is not verified. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00492,0.701818634191539,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount,"This claim has a 70% estimated denial probability, mainly due to documentation appears incomplete or missing, and expected payment is low relative to billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00439,0.6998955245583992,1,High,documentation appears incomplete or missing; referral required but not present; claim has relatively high procedure/diagnosis complexity,"This claim has a 70% estimated denial probability, mainly due to documentation appears incomplete or missing, referral required but not present, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00042,0.6997855156758814,1,High,authorization required but not on file; documentation appears incomplete or missing,"This claim has a 70% estimated denial probability, mainly due to authorization required but not on file, and documentation appears incomplete or missing. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00180,0.6984459710361463,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 70% estimated denial probability, mainly due to documentation appears incomplete or missing, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00117,0.6964676641376378,1,High,patient eligibility is not verified; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 70% estimated denial probability, mainly due to patient eligibility is not verified, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00085,0.6960109007609259,1,High,authorization required but not on file; visit type has elevated historical denial risk,"This claim has a 70% estimated denial probability, mainly due to authorization required but not on file, and visit type has elevated historical denial risk. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00116,0.6874409472982669,1,High,patient eligibility is not verified; referral required but not present; claim has relatively high procedure/diagnosis complexity,"This claim has a 69% estimated denial probability, mainly due to patient eligibility is not verified, referral required but not present, and claim has relatively high procedure/diagnosis complexity. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00471,0.6860650311686609,1,High,authorization required but not on file; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 69% estimated denial probability, mainly due to authorization required but not on file, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00094,0.6858322061001839,1,High,authorization required but not on file; claim was submitted more than 30 days after service; provider is out of network for the payer,"This claim has a 69% estimated denial probability, mainly due to authorization required but not on file, claim was submitted more than 30 days after service, and provider is out of network for the payer. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00338,0.6857798831551662,1,High,patient eligibility is not verified; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 69% estimated denial probability, mainly due to patient eligibility is not verified, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00068,0.6826542270105413,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 68% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00104,0.6815262759371323,1,High,authorization required but not on file; claim was submitted more than 30 days after service,"This claim has a 68% estimated denial probability, mainly due to authorization required but not on file, and claim was submitted more than 30 days after service. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00137,0.6789982574946453,1,High,patient eligibility is not verified; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 68% estimated denial probability, mainly due to patient eligibility is not verified, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00203,0.6780965350069513,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 68% estimated denial probability, mainly due to documentation appears incomplete or missing, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00011,0.6758253043518994,1,High,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 68% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00252,0.67484584463038,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 67% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00377,0.673582094850792,1,High,authorization required but not on file; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 67% estimated denial probability, mainly due to authorization required but not on file, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00204,0.6724399525286243,1,High,documentation appears incomplete or missing; referral required but not present,"This claim has a 67% estimated denial probability, mainly due to documentation appears incomplete or missing, and referral required but not present. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00381,0.6723733432431732,1,High,documentation appears incomplete or missing; claim was submitted more than 45 days after service; claim was submitted more than 30 days after service,"This claim has a 67% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 45 days after service, and claim was submitted more than 30 days after service. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00432,0.6704409677533193,1,High,authorization required but not on file; documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity,"This claim has a 67% estimated denial probability, mainly due to authorization required but not on file, documentation appears incomplete or missing, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00224,0.6696857306459157,1,High,authorization required but not on file; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 67% estimated denial probability, mainly due to authorization required but not on file, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00130,0.669485371536699,1,High,documentation appears incomplete or missing,"This claim has a 67% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00019,0.6682639107278914,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 67% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00334,0.6618049884491817,1,High,patient eligibility is not verified; claim was submitted more than 30 days after service,"This claim has a 66% estimated denial probability, mainly due to patient eligibility is not verified, and claim was submitted more than 30 days after service. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00207,0.6591498282544128,1,High,referral required but not present; claim was submitted more than 30 days after service,"This claim has a 66% estimated denial probability, mainly due to referral required but not present, and claim was submitted more than 30 days after service. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00392,0.6580524617494325,1,High,referral required but not present; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 66% estimated denial probability, mainly due to referral required but not present, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00468,0.6575938058305903,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 66% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00058,0.6546490544247167,1,High,documentation appears incomplete or missing; patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity,"This claim has a 65% estimated denial probability, mainly due to documentation appears incomplete or missing, patient eligibility is not verified, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00388,0.6542067601355567,1,High,referral required but not present; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 65% estimated denial probability, mainly due to referral required but not present, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00217,0.6527687568838421,1,High,authorization required but not on file; claim has a relatively high billed amount,"This claim has a 65% estimated denial probability, mainly due to authorization required but not on file, and claim has a relatively high billed amount. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00222,0.651655956871927,1,High,patient eligibility is not verified; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 65% estimated denial probability, mainly due to patient eligibility is not verified, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00295,0.6491709402833743,1,High,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 65% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00174,0.6480764665632848,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity,"This claim has a 65% estimated denial probability, mainly due to documentation appears incomplete or missing, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00270,0.6462931090491779,1,High,claim was submitted more than 30 days after service; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 65% estimated denial probability, mainly due to claim was submitted more than 30 days after service, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00055,0.642433812038977,1,High,authorization required but not on file,"This claim has a 64% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00255,0.641572465529228,1,High,authorization required but not on file,"This claim has a 64% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00239,0.6408968626258745,1,High,authorization required but not on file; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 64% estimated denial probability, mainly due to authorization required but not on file, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00385,0.6388919614004176,1,High,documentation appears incomplete or missing; visit type has elevated historical denial risk,"This claim has a 64% estimated denial probability, mainly due to documentation appears incomplete or missing, and visit type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00108,0.6369723877511936,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount,"This claim has a 64% estimated denial probability, mainly due to documentation appears incomplete or missing, and expected payment is low relative to billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00402,0.6364756013567616,1,High,authorization required but not on file; claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity,"This claim has a 64% estimated denial probability, mainly due to authorization required but not on file, claim was submitted more than 30 days after service, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00254,0.6349141015497206,1,High,documentation appears incomplete or missing; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 63% estimated denial probability, mainly due to documentation appears incomplete or missing, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00124,0.6335568477231379,1,High,claim was submitted more than 45 days after service; claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity,"This claim has a 63% estimated denial probability, mainly due to claim was submitted more than 45 days after service, claim was submitted more than 30 days after service, and claim has relatively high procedure/diagnosis complexity. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00139,0.6335068453803192,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 63% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00317,0.633453957778882,1,High,documentation appears incomplete or missing; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 63% estimated denial probability, mainly due to documentation appears incomplete or missing, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00294,0.629255614356385,1,High,authorization required but not on file; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 63% estimated denial probability, mainly due to authorization required but not on file, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00324,0.6261477562824894,1,High,authorization required but not on file; visit type has elevated historical denial risk,"This claim has a 63% estimated denial probability, mainly due to authorization required but not on file, and visit type has elevated historical denial risk. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00365,0.626014070654918,1,High,documentation appears incomplete or missing; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 63% estimated denial probability, mainly due to documentation appears incomplete or missing, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00455,0.6243894443890204,1,High,referral required but not present; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 62% estimated denial probability, mainly due to referral required but not present, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00310,0.6239426110480916,1,High,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 62% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00410,0.6238438616348122,1,High,patient eligibility is not verified; claim was submitted more than 30 days after service; provider is out of network for the payer,"This claim has a 62% estimated denial probability, mainly due to patient eligibility is not verified, claim was submitted more than 30 days after service, and provider is out of network for the payer. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00103,0.6234046549100015,1,High,authorization required but not on file,"This claim has a 62% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00461,0.6197699999822706,1,High,authorization required but not on file; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 62% estimated denial probability, mainly due to authorization required but not on file, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00345,0.617496029548922,1,High,patient eligibility is not verified; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 62% estimated denial probability, mainly due to patient eligibility is not verified, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00313,0.6154779895926282,1,High,claim was submitted more than 30 days after service; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 62% estimated denial probability, mainly due to claim was submitted more than 30 days after service, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00189,0.6154121716491536,1,High,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 62% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00305,0.6149134442165302,1,High,claim was submitted more than 30 days after service; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 61% estimated denial probability, mainly due to claim was submitted more than 30 days after service, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00088,0.6068111866463081,1,High,patient eligibility is not verified; provider is out of network for the payer; expected payment is low relative to billed amount,"This claim has a 61% estimated denial probability, mainly due to patient eligibility is not verified, provider is out of network for the payer, and expected payment is low relative to billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00003,0.6061711686632039,1,High,patient eligibility is not verified,"This claim has a 61% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00098,0.6053622895294634,1,High,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 61% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00231,0.6051531075483311,1,High,patient eligibility is not verified; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 61% estimated denial probability, mainly due to patient eligibility is not verified, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00263,0.6004674697368191,1,High,authorization required but not on file,"This claim has a 60% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00288,0.5999517361690272,1,High,patient eligibility is not verified; provider is out of network for the payer; expected payment is low relative to billed amount,"This claim has a 60% estimated denial probability, mainly due to patient eligibility is not verified, provider is out of network for the payer, and expected payment is low relative to billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00447,0.5982995140614727,1,High,claim was submitted more than 45 days after service; claim was submitted more than 30 days after service; claim has a relatively high billed amount,"This claim has a 60% estimated denial probability, mainly due to claim was submitted more than 45 days after service, claim was submitted more than 30 days after service, and claim has a relatively high billed amount. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00299,0.5968448308087093,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 60% estimated denial probability, mainly due to documentation appears incomplete or missing, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00006,0.5964513860860846,1,High,documentation appears incomplete or missing; provider is out of network for the payer,"This claim has a 60% estimated denial probability, mainly due to documentation appears incomplete or missing, and provider is out of network for the payer. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00209,0.5933825715878582,1,High,patient eligibility is not verified; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 59% estimated denial probability, mainly due to patient eligibility is not verified, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00143,0.5913516802774603,1,High,authorization required but not on file,"This claim has a 59% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00032,0.5886662776964338,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity,"This claim has a 59% estimated denial probability, mainly due to documentation appears incomplete or missing, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00405,0.5859080896469236,1,High,documentation appears incomplete or missing,"This claim has a 59% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00382,0.5852008746148016,1,High,referral required but not present; claim has relatively high procedure/diagnosis complexity; payer type has elevated historical denial risk,"This claim has a 59% estimated denial probability, mainly due to referral required but not present, claim has relatively high procedure/diagnosis complexity, and payer type has elevated historical denial risk. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00182,0.5851202014103615,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount,"This claim has a 59% estimated denial probability, mainly due to documentation appears incomplete or missing, and expected payment is low relative to billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00240,0.5846210266099622,1,High,documentation appears incomplete or missing; visit type has elevated historical denial risk,"This claim has a 58% estimated denial probability, mainly due to documentation appears incomplete or missing, and visit type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00054,0.5837965235462392,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 58% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00053,0.583574566895207,1,High,documentation appears incomplete or missing,"This claim has a 58% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00102,0.5828637019555785,1,High,claim was submitted more than 30 days after service; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 58% estimated denial probability, mainly due to claim was submitted more than 30 days after service, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00187,0.5817418356011578,1,High,documentation appears incomplete or missing; claim has a relatively high billed amount,"This claim has a 58% estimated denial probability, mainly due to documentation appears incomplete or missing, and claim has a relatively high billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00431,0.5810666528222865,1,High,documentation appears incomplete or missing,"This claim has a 58% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00154,0.5804606633727946,1,High,authorization required but not on file,"This claim has a 58% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00473,0.5766119915220492,1,High,documentation appears incomplete or missing; claim was submitted more than 30 days after service; claim has a relatively high billed amount,"This claim has a 58% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 30 days after service, and claim has a relatively high billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00166,0.5740282906295564,1,High,documentation appears incomplete or missing,"This claim has a 57% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00046,0.5734209783381654,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 57% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00326,0.5725723987747958,1,High,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; payer type has elevated historical denial risk,"This claim has a 57% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00017,0.5725303494307926,1,High,documentation appears incomplete or missing,"This claim has a 57% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00173,0.5716867749275574,1,High,claim was submitted more than 30 days after service; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 57% estimated denial probability, mainly due to claim was submitted more than 30 days after service, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00044,0.5702333676252157,1,High,patient eligibility is not verified; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 57% estimated denial probability, mainly due to patient eligibility is not verified, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00308,0.5692569797580704,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 57% estimated denial probability, mainly due to documentation appears incomplete or missing, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00311,0.567531255271578,1,High,authorization required but not on file; claim has relatively high procedure/diagnosis complexity,"This claim has a 57% estimated denial probability, mainly due to authorization required but not on file, and claim has relatively high procedure/diagnosis complexity. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00115,0.5666862198134335,1,High,documentation appears incomplete or missing; claim was submitted more than 45 days after service; claim was submitted more than 30 days after service,"This claim has a 57% estimated denial probability, mainly due to documentation appears incomplete or missing, claim was submitted more than 45 days after service, and claim was submitted more than 30 days after service. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00491,0.5658796909192401,1,High,documentation appears incomplete or missing; expected payment is low relative to billed amount,"This claim has a 57% estimated denial probability, mainly due to documentation appears incomplete or missing, and expected payment is low relative to billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00443,0.5607810683155168,1,High,claim was submitted more than 30 days after service; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 56% estimated denial probability, mainly due to claim was submitted more than 30 days after service, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00077,0.5598690222367304,1,High,referral required but not present; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 56% estimated denial probability, mainly due to referral required but not present, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00378,0.5586267038908954,1,High,claim was submitted more than 30 days after service; provider is out of network for the payer; expected payment is low relative to billed amount,"This claim has a 56% estimated denial probability, mainly due to claim was submitted more than 30 days after service, provider is out of network for the payer, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00304,0.5580199941820615,1,High,patient eligibility is not verified,"This claim has a 56% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00190,0.5578176190834595,1,High,patient eligibility is not verified; provider is out of network for the payer; expected payment is low relative to billed amount,"This claim has a 56% estimated denial probability, mainly due to patient eligibility is not verified, provider is out of network for the payer, and expected payment is low relative to billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00494,0.556999483911178,1,High,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 56% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00157,0.556039450425545,1,High,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 56% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00376,0.5549824124975136,1,High,claim was submitted more than 30 days after service; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 55% estimated denial probability, mainly due to claim was submitted more than 30 days after service, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00196,0.5546988335423199,1,High,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 55% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00328,0.5539071650173107,1,High,referral required but not present; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 55% estimated denial probability, mainly due to referral required but not present, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00364,0.553151340040422,1,High,documentation appears incomplete or missing; visit type has elevated historical denial risk,"This claim has a 55% estimated denial probability, mainly due to documentation appears incomplete or missing, and visit type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00269,0.5512543721405425,1,High,referral required but not present; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 55% estimated denial probability, mainly due to referral required but not present, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00230,0.5506880273446767,1,High,claim was submitted more than 45 days after service; claim was submitted more than 30 days after service; payer type has elevated historical denial risk,"This claim has a 55% estimated denial probability, mainly due to claim was submitted more than 45 days after service, claim was submitted more than 30 days after service, and payer type has elevated historical denial risk. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00234,0.5429791337215488,1,High,authorization required but not on file,"This claim has a 54% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00253,0.5424657433781507,1,High,patient eligibility is not verified; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 54% estimated denial probability, mainly due to patient eligibility is not verified, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00195,0.5395640187949462,1,High,claim has a relatively high billed amount; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 54% estimated denial probability, mainly due to claim has a relatively high billed amount, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00397,0.5393016201308373,1,High,provider is out of network for the payer; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 54% estimated denial probability, mainly due to provider is out of network for the payer, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00235,0.5374599931415649,1,High,claim was submitted more than 30 days after service; provider is out of network for the payer; expected payment is low relative to billed amount,"This claim has a 54% estimated denial probability, mainly due to claim was submitted more than 30 days after service, provider is out of network for the payer, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00384,0.535841356528143,1,High,documentation appears incomplete or missing,"This claim has a 54% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00401,0.5346896413824083,1,High,documentation appears incomplete or missing,"This claim has a 53% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00092,0.5343525170078502,1,High,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 53% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00247,0.5340598214072716,1,High,provider is out of network for the payer; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 53% estimated denial probability, mainly due to provider is out of network for the payer, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00248,0.5328901757736423,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 53% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00354,0.5317836962841433,1,High,claim was submitted more than 30 days after service; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 53% estimated denial probability, mainly due to claim was submitted more than 30 days after service, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00039,0.5300739001335933,1,High,documentation appears incomplete or missing,"This claim has a 53% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00191,0.5296635523674127,1,High,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 53% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00413,0.52917159339668,1,High,patient eligibility is not verified,"This claim has a 53% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00009,0.5264313044536861,1,High,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 53% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00215,0.5259137779858486,1,High,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 53% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00360,0.5257917247845718,1,High,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 53% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00005,0.5242259421598859,1,High,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 52% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00206,0.524001118869515,1,High,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 52% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00474,0.5237611042343944,1,High,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 52% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00475,0.523295526726278,1,High,patient eligibility is not verified,"This claim has a 52% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00126,0.5229888361182035,1,High,documentation appears incomplete or missing; claim was submitted more than 30 days after service,"This claim has a 52% estimated denial probability, mainly due to documentation appears incomplete or missing, and claim was submitted more than 30 days after service. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00151,0.522892641076748,1,High,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity,"This claim has a 52% estimated denial probability, mainly due to patient eligibility is not verified, and claim has relatively high procedure/diagnosis complexity. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00375,0.522846243709709,1,High,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 52% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00435,0.5218727662896208,1,High,provider is out of network for the payer; claim has a relatively high billed amount; payer type has elevated historical denial risk,"This claim has a 52% estimated denial probability, mainly due to provider is out of network for the payer, claim has a relatively high billed amount, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00467,0.5214526485826266,1,High,expected payment is low relative to billed amount; payer type has elevated historical denial risk; visit type has elevated historical denial risk,"This claim has a 52% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00318,0.5194985912689964,1,High,authorization required but not on file; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 52% estimated denial probability, mainly due to authorization required but not on file, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00296,0.5172886587701885,1,High,patient eligibility is not verified; claim has a relatively high billed amount,"This claim has a 52% estimated denial probability, mainly due to patient eligibility is not verified, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00158,0.5171216290173773,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 52% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00421,0.5168832418676131,1,High,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 52% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00202,0.5125234629361307,1,High,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 51% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00488,0.5116274866508705,1,High,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 51% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00478,0.5112643648666094,1,High,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 51% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00339,0.5108786866018726,1,High,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 51% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00268,0.5108499031243005,1,High,claim was submitted more than 30 days after service; provider is out of network for the payer; claim has a relatively high billed amount,"This claim has a 51% estimated denial probability, mainly due to claim was submitted more than 30 days after service, provider is out of network for the payer, and claim has a relatively high billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00168,0.5062041766485997,1,High,referral required but not present; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 51% estimated denial probability, mainly due to referral required but not present, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00341,0.5053989288812616,1,High,referral required but not present,"This claim has a 51% estimated denial probability, mainly due to referral required but not present. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00040,0.5039272157267022,1,High,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 50% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00178,0.4974174851161909,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 50% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00282,0.49625899016560804,1,Medium,referral required but not present; expected payment is low relative to billed amount,"This claim has a 50% estimated denial probability, mainly due to referral required but not present, and expected payment is low relative to billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00184,0.4944804994563582,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; payer type has elevated historical denial risk,"This claim has a 49% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00487,0.4940469184782674,1,Medium,claim was submitted more than 30 days after service,"This claim has a 49% estimated denial probability, mainly due to claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00073,0.4936339756202616,1,Medium,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 49% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00390,0.4898962935856186,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 49% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00257,0.488588808965164,1,Medium,claim has a relatively high billed amount,"This claim has a 49% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00114,0.48443891421865387,1,Medium,claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 48% estimated denial probability, mainly due to claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00314,0.4791078027769974,1,Medium,referral required but not present; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 48% estimated denial probability, mainly due to referral required but not present, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00004,0.47740588728734357,1,Medium,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 48% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00192,0.477186487926816,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 48% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00212,0.47677183415981245,1,Medium,referral required but not present; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 48% estimated denial probability, mainly due to referral required but not present, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00331,0.4762398680504347,1,Medium,patient eligibility is not verified,"This claim has a 48% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00464,0.4760770753642362,1,Medium,claim was submitted more than 30 days after service; claim has a relatively high billed amount,"This claim has a 48% estimated denial probability, mainly due to claim was submitted more than 30 days after service, and claim has a relatively high billed amount. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00199,0.4742549497928276,1,Medium,patient eligibility is not verified,"This claim has a 47% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00014,0.4714718326121268,1,Medium,referral required but not present; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 47% estimated denial probability, mainly due to referral required but not present, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00045,0.4711133023381522,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 47% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00408,0.470595005818278,1,Medium,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 47% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00412,0.46478763941504253,1,Medium,patient eligibility is not verified; claim was submitted more than 30 days after service,"This claim has a 46% estimated denial probability, mainly due to patient eligibility is not verified, and claim was submitted more than 30 days after service. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00142,0.46458945305319566,1,Medium,authorization required but not on file,"This claim has a 46% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00080,0.4621284577476685,1,Medium,claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity,"This claim has a 46% estimated denial probability, mainly due to claim was submitted more than 30 days after service, and claim has relatively high procedure/diagnosis complexity. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00337,0.4613027027051506,1,Medium,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 46% estimated denial probability, mainly due to documentation appears incomplete or missing, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00424,0.46104430134194707,1,Medium,claim was submitted more than 30 days after service; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 46% estimated denial probability, mainly due to claim was submitted more than 30 days after service, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00128,0.46098998181611445,1,Medium,provider is out of network for the payer; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 46% estimated denial probability, mainly due to provider is out of network for the payer, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00110,0.4590448839938058,1,Medium,payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 46% estimated denial probability, mainly due to payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00450,0.4567505795651893,1,Medium,referral required but not present; expected payment is low relative to billed amount,"This claim has a 46% estimated denial probability, mainly due to referral required but not present, and expected payment is low relative to billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00441,0.4551104137489471,1,Medium,patient eligibility is not verified,"This claim has a 46% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00404,0.45365200380791426,1,Medium,provider is out of network for the payer; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 45% estimated denial probability, mainly due to provider is out of network for the payer, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00418,0.4510620678828649,1,Medium,claim has a relatively high billed amount,"This claim has a 45% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00171,0.44978550360130487,1,Medium,documentation appears incomplete or missing,"This claim has a 45% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00145,0.4490672085821782,1,Medium,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 45% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00050,0.44837672786052557,1,Medium,patient eligibility is not verified; claim has a relatively high billed amount,"This claim has a 45% estimated denial probability, mainly due to patient eligibility is not verified, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00015,0.44778278919523656,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 45% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00262,0.44697423919154755,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 45% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00312,0.4454808504174612,1,Medium,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity,"This claim has a 45% estimated denial probability, mainly due to documentation appears incomplete or missing, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00371,0.44369900598623724,1,Medium,authorization required but not on file,"This claim has a 44% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00448,0.44296639993338,1,Medium,authorization required but not on file,"This claim has a 44% estimated denial probability, mainly due to authorization required but not on file. Before submission, verify whether prior authorization exists or obtain it. This is a risk estimate, not a guarantee of denial."
CCLM-00061,0.4428571743171585,1,Medium,claim was submitted more than 30 days after service; provider is out of network for the payer,"This claim has a 44% estimated denial probability, mainly due to claim was submitted more than 30 days after service, and provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00025,0.4405485480823132,1,Medium,referral required but not present; claim has a relatively high billed amount,"This claim has a 44% estimated denial probability, mainly due to referral required but not present, and claim has a relatively high billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00156,0.44041217439347985,1,Medium,referral required but not present; provider is out of network for the payer; payer type has elevated historical denial risk,"This claim has a 44% estimated denial probability, mainly due to referral required but not present, provider is out of network for the payer, and payer type has elevated historical denial risk. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00120,0.43848524246476767,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 44% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00321,0.4375128846675662,1,Medium,documentation appears incomplete or missing,"This claim has a 44% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00121,0.43720175759244606,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 44% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00036,0.43675615826708286,1,Medium,claim was submitted more than 45 days after service; claim was submitted more than 30 days after service,"This claim has a 44% estimated denial probability, mainly due to claim was submitted more than 45 days after service, and claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00369,0.43615424348351906,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 44% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00466,0.43564710140169033,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 44% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00436,0.43501968698667687,1,Medium,claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 44% estimated denial probability, mainly due to claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00012,0.432126700353042,1,Medium,expected payment is low relative to billed amount,"This claim has a 43% estimated denial probability, mainly due to expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00122,0.4318981604657828,1,Medium,expected payment is low relative to billed amount,"This claim has a 43% estimated denial probability, mainly due to expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00048,0.4291311979596411,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 43% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00002,0.42850998752065234,1,Medium,claim was submitted more than 30 days after service,"This claim has a 43% estimated denial probability, mainly due to claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00495,0.42779725879690744,1,Medium,expected payment is low relative to billed amount,"This claim has a 43% estimated denial probability, mainly due to expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00333,0.4269863195379516,1,Medium,provider is out of network for the payer,"This claim has a 43% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00411,0.42568122258934343,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 43% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00393,0.42512362758508054,1,Medium,documentation appears incomplete or missing,"This claim has a 43% estimated denial probability, mainly due to documentation appears incomplete or missing. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00070,0.4244368465019917,1,Medium,claim was submitted more than 30 days after service,"This claim has a 42% estimated denial probability, mainly due to claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00065,0.4217122704989664,1,Medium,claim was submitted more than 30 days after service; provider is out of network for the payer,"This claim has a 42% estimated denial probability, mainly due to claim was submitted more than 30 days after service, and provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00144,0.4213497751285442,1,Medium,provider is out of network for the payer; claim has a relatively high billed amount; payer type has elevated historical denial risk,"This claim has a 42% estimated denial probability, mainly due to provider is out of network for the payer, claim has a relatively high billed amount, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00194,0.42087937745437815,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 42% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00275,0.42076973352939356,1,Medium,claim has a relatively high billed amount; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 42% estimated denial probability, mainly due to claim has a relatively high billed amount, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00101,0.42062887348894684,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 42% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00233,0.4200216307762776,1,Medium,referral required but not present; claim has a relatively high billed amount,"This claim has a 42% estimated denial probability, mainly due to referral required but not present, and claim has a relatively high billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00498,0.41928762956095117,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 42% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00373,0.41843642612546317,1,Medium,claim was submitted more than 45 days after service; claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity,"This claim has a 42% estimated denial probability, mainly due to claim was submitted more than 45 days after service, claim was submitted more than 30 days after service, and claim has relatively high procedure/diagnosis complexity. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00251,0.4155278169731722,1,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 42% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00278,0.41548812157712306,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 42% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00315,0.4151311966838135,1,Medium,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 42% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00320,0.4150232864145715,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 42% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00430,0.41454660044829084,1,Medium,patient eligibility is not verified,"This claim has a 41% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00422,0.4129857419213314,1,Medium,provider is out of network for the payer; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 41% estimated denial probability, mainly due to provider is out of network for the payer, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00484,0.4122337265438255,1,Medium,expected payment is low relative to billed amount,"This claim has a 41% estimated denial probability, mainly due to expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00379,0.41193468965086194,1,Medium,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 41% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00423,0.4108309790524133,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 41% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00452,0.41021621622101,1,Medium,provider is out of network for the payer; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 41% estimated denial probability, mainly due to provider is out of network for the payer, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00089,0.40970973740064376,1,Medium,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 41% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00076,0.4092452269891504,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 41% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00394,0.40904964128177873,1,Medium,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; payer type has elevated historical denial risk,"This claim has a 41% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00067,0.406587858276432,1,Medium,claim has a relatively high billed amount; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 41% estimated denial probability, mainly due to claim has a relatively high billed amount, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00149,0.4033832478334384,1,Medium,claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 40% estimated denial probability, mainly due to claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00148,0.4010744705156114,1,Medium,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 40% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00020,0.3987304174170343,1,Medium,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 40% estimated denial probability, mainly due to patient eligibility is not verified, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00449,0.39795974937932327,1,Medium,provider is out of network for the payer; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 40% estimated denial probability, mainly due to provider is out of network for the payer, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00018,0.3972737613799823,1,Medium,provider is out of network for the payer; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 40% estimated denial probability, mainly due to provider is out of network for the payer, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00081,0.3972531642979225,1,Medium,expected payment is low relative to billed amount,"This claim has a 40% estimated denial probability, mainly due to expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00319,0.3964487434903108,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; visit type has elevated historical denial risk,"This claim has a 40% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00291,0.39642765325106355,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 40% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00113,0.3959751468375627,1,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 40% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00286,0.39580795310027883,1,Medium,referral required but not present,"This claim has a 40% estimated denial probability, mainly due to referral required but not present. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00031,0.39259745384420597,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 39% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00220,0.39223785279777845,1,Medium,referral required but not present,"This claim has a 39% estimated denial probability, mainly due to referral required but not present. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00349,0.3905512771504834,1,Medium,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount; visit type has elevated historical denial risk,"This claim has a 39% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, expected payment is low relative to billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00091,0.38915004396636194,1,Medium,claim was submitted more than 30 days after service,"This claim has a 39% estimated denial probability, mainly due to claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00359,0.38827298407217237,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 39% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00325,0.3863451741530042,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 39% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00287,0.38481996505940336,1,Medium,documentation appears incomplete or missing; provider is out of network for the payer,"This claim has a 38% estimated denial probability, mainly due to documentation appears incomplete or missing, and provider is out of network for the payer. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00159,0.3832018893281661,1,Medium,claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 38% estimated denial probability, mainly due to claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00052,0.38224871809159056,1,Medium,documentation appears incomplete or missing; claim has relatively high procedure/diagnosis complexity,"This claim has a 38% estimated denial probability, mainly due to documentation appears incomplete or missing, and claim has relatively high procedure/diagnosis complexity. Before submission, attach or verify the required supporting documentation. This is a risk estimate, not a guarantee of denial."
CCLM-00398,0.3803245084089248,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 38% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00238,0.37852152113888077,1,Medium,claim was submitted more than 30 days after service,"This claim has a 38% estimated denial probability, mainly due to claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00472,0.37687202019943455,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 38% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00229,0.37575495019415506,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 38% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00271,0.3756516900312516,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; expected payment is low relative to billed amount,"This claim has a 38% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00141,0.3745595531303691,1,Medium,claim has a relatively high billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 37% estimated denial probability, mainly due to claim has a relatively high billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00074,0.37446519401424233,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 37% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00362,0.37439289607875204,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 37% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00437,0.37388714690715324,1,Medium,payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 37% estimated denial probability, mainly due to payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00332,0.37280829193343984,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 37% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00162,0.3727554484869629,1,Medium,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 37% estimated denial probability, mainly due to provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00216,0.3720143374632799,1,Medium,patient eligibility is not verified,"This claim has a 37% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00007,0.371946461592479,1,Medium,patient eligibility is not verified; claim has relatively high procedure/diagnosis complexity,"This claim has a 37% estimated denial probability, mainly due to patient eligibility is not verified, and claim has relatively high procedure/diagnosis complexity. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00150,0.37076011515724167,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 37% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00355,0.3688448909149835,1,Medium,claim was submitted more than 30 days after service; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 37% estimated denial probability, mainly due to claim was submitted more than 30 days after service, claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00097,0.3683252334956595,1,Medium,provider is out of network for the payer,"This claim has a 37% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00486,0.36749164961647296,1,Medium,claim has a relatively high billed amount,"This claim has a 37% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00118,0.3671236446685725,1,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 37% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00440,0.36666142368767,1,Medium,visit type has elevated historical denial risk,"This claim has a 37% estimated denial probability, mainly due to visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00030,0.3662661163651958,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 37% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00281,0.3636540648505332,1,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 36% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00460,0.3623833160700766,1,Medium,provider is out of network for the payer,"This claim has a 36% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00109,0.3619281995379357,1,Medium,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 36% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00169,0.36181003005623524,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 36% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00183,0.35817074285826234,1,Medium,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 36% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00075,0.35792978177397833,1,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 36% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00428,0.356988459987948,1,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 36% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00164,0.35439661214898205,0,Medium,payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 35% estimated denial probability, mainly due to payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00086,0.3542043388537392,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 35% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00444,0.35419519638739716,0,Medium,provider is out of network for the payer,"This claim has a 35% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00438,0.35324769941430023,0,Medium,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 35% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00451,0.3528933240614753,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 35% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00219,0.3516581909817358,0,Medium,patient eligibility is not verified,"This claim has a 35% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00367,0.35160223383107964,0,Medium,payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 35% estimated denial probability, mainly due to payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00249,0.3515745997659611,0,Medium,claim has a relatively high billed amount,"This claim has a 35% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00496,0.35142082412113296,0,Medium,expected payment is low relative to billed amount,"This claim has a 35% estimated denial probability, mainly due to expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00429,0.350385549384808,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 35% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00374,0.34994873981852354,0,Medium,claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 35% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00079,0.34764545966556976,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 35% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00245,0.3470685677072578,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 35% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00243,0.34586076681496497,0,Medium,claim has a relatively high billed amount,"This claim has a 35% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00035,0.3451613020544791,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 35% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00140,0.3448594071047165,0,Medium,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; expected payment is low relative to billed amount,"This claim has a 34% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and expected payment is low relative to billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00489,0.3408434153540743,0,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 34% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00024,0.3397342632137635,0,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 34% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00479,0.3393494049184015,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 34% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00112,0.33908082700954245,0,Medium,claim has a relatively high billed amount,"This claim has a 34% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00316,0.33876316874118256,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 34% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00298,0.3373168701345924,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 34% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00060,0.3367927210765765,0,Medium,claim has a relatively high billed amount,"This claim has a 34% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00200,0.3360501585578278,0,Medium,claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 34% estimated denial probability, mainly due to claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00066,0.3355689662718358,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 34% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00260,0.33513307203472925,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 34% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00350,0.3346023934182934,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 33% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00038,0.3342701089464481,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 33% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00301,0.3332228582814601,0,Medium,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 33% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00302,0.3327503047363451,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 33% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00283,0.33211613963039466,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 33% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00457,0.3317690499403209,0,Medium,claim has a relatively high billed amount,"This claim has a 33% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00008,0.3316792478549292,0,Medium,claim has a relatively high billed amount,"This claim has a 33% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00409,0.33090501991723503,0,Medium,patient eligibility is not verified,"This claim has a 33% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00351,0.33026635610649674,0,Medium,claim has a relatively high billed amount,"This claim has a 33% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00129,0.3272907539982132,0,Medium,claim has a relatively high billed amount,"This claim has a 33% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00277,0.3257371656960441,0,Medium,referral required but not present; provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity,"This claim has a 33% estimated denial probability, mainly due to referral required but not present, provider is out of network for the payer, and claim has relatively high procedure/diagnosis complexity. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00434,0.32512185864400456,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 33% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00106,0.32506100259127224,0,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 33% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00160,0.32338686233149344,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 32% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00246,0.3211475090650631,0,Medium,claim was submitted more than 30 days after service,"This claim has a 32% estimated denial probability, mainly due to claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00069,0.32085328092706417,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 32% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00391,0.32032824311692093,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 32% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00021,0.3197880631373137,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 32% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00188,0.3180476798916575,0,Medium,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 32% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00071,0.3166703254665854,0,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 32% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00469,0.31524155920501723,0,Medium,provider is out of network for the payer; expected payment is low relative to billed amount; payer type has elevated historical denial risk,"This claim has a 32% estimated denial probability, mainly due to provider is out of network for the payer, expected payment is low relative to billed amount, and payer type has elevated historical denial risk. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00414,0.3148594909250774,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 31% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00309,0.3147295691966435,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 31% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00181,0.3141748983493979,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 31% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00016,0.31384497957863294,0,Medium,claim has a relatively high billed amount,"This claim has a 31% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00417,0.31228569906672754,0,Medium,claim was submitted more than 30 days after service,"This claim has a 31% estimated denial probability, mainly due to claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00400,0.3111169713701243,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 31% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00057,0.3106928885066763,0,Medium,payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 31% estimated denial probability, mainly due to payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00480,0.3100181471063235,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 31% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00047,0.30740562729229093,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 31% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00059,0.3071972627470228,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 31% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00241,0.3071776863721996,0,Medium,claim was submitted more than 30 days after service,"This claim has a 31% estimated denial probability, mainly due to claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00330,0.305597194666475,0,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 31% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00201,0.305049862705321,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 31% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00227,0.30468357301477045,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 30% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00292,0.30468014837383467,0,Medium,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 30% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00107,0.3044994201127422,0,Medium,patient eligibility is not verified,"This claim has a 30% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00043,0.3042285990810982,0,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 30% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00395,0.30305089015590997,0,Medium,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 30% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00343,0.30128319171345047,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 30% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00083,0.30093191917878565,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 30% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00454,0.30011089354418424,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 30% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00223,0.2993368789174717,0,Medium,expected payment is low relative to billed amount,"This claim has a 30% estimated denial probability, mainly due to expected payment is low relative to billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00346,0.299267296563788,0,Medium,provider is out of network for the payer,"This claim has a 30% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00453,0.2980120519425056,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 30% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00420,0.29765744067594113,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 30% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00353,0.29654644498860233,0,Medium,claim was submitted more than 30 days after service; provider is out of network for the payer,"This claim has a 30% estimated denial probability, mainly due to claim was submitted more than 30 days after service, and provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00497,0.2951374854451592,0,Medium,patient eligibility is not verified; provider is out of network for the payer,"This claim has a 30% estimated denial probability, mainly due to patient eligibility is not verified, and provider is out of network for the payer. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00266,0.2935943528111109,0,Medium,claim was submitted more than 45 days after service; claim was submitted more than 30 days after service,"This claim has a 29% estimated denial probability, mainly due to claim was submitted more than 45 days after service, and claim was submitted more than 30 days after service. Before submission, review timely-filing requirements for this payer. This is a risk estimate, not a guarantee of denial."
CCLM-00132,0.29195818408762436,0,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 29% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00261,0.29154964264760674,0,Medium,provider is out of network for the payer,"This claim has a 29% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00306,0.29003882332129,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 29% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00366,0.28887904194115044,0,Medium,patient eligibility is not verified,"This claim has a 29% estimated denial probability, mainly due to patient eligibility is not verified. Before submission, re-check the patient's active coverage and eligibility. This is a risk estimate, not a guarantee of denial."
CCLM-00483,0.2885188103541756,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 29% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00396,0.2881353346532476,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 29% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00095,0.28731687192144406,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 29% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00127,0.2872595323781179,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 29% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00256,0.28566683232025303,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 29% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00493,0.2845378420080963,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 28% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00297,0.2828380682095582,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 28% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00348,0.28282370714344424,0,Medium,referral required but not present; claim has relatively high procedure/diagnosis complexity,"This claim has a 28% estimated denial probability, mainly due to referral required but not present, and claim has relatively high procedure/diagnosis complexity. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00389,0.2813848307063364,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 28% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00490,0.28104628583005786,0,Medium,referral required but not present; provider is out of network for the payer,"This claim has a 28% estimated denial probability, mainly due to referral required but not present, and provider is out of network for the payer. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00293,0.27874220680118256,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 28% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00226,0.27720019550921565,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 28% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00027,0.2764207810697306,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 28% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00064,0.27440046844300553,0,Medium,expected payment is low relative to billed amount; payer type has elevated historical denial risk; payer has elevated historical denial risk,"This claim has a 27% estimated denial probability, mainly due to expected payment is low relative to billed amount, payer type has elevated historical denial risk, and payer has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00276,0.2731257100533395,0,Medium,provider is out of network for the payer,"This claim has a 27% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00218,0.2730802816189126,0,Medium,provider is out of network for the payer,"This claim has a 27% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00131,0.2718685204203172,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 27% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00172,0.2711076127193828,0,Medium,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 27% estimated denial probability, mainly due to provider is out of network for the payer, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00133,0.27032146324361706,0,Medium,provider is out of network for the payer,"This claim has a 27% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00210,0.2702904633939988,0,Medium,claim has a relatively high billed amount,"This claim has a 27% estimated denial probability, mainly due to claim has a relatively high billed amount. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00363,0.26863115215723427,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 27% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00335,0.2665744579290263,0,Medium,provider is out of network for the payer,"This claim has a 27% estimated denial probability, mainly due to provider is out of network for the payer. Before submission, verify network status and payer-specific handling. This is a risk estimate, not a guarantee of denial."
CCLM-00197,0.2642722968633347,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 26% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00111,0.2620300876310777,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 26% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00211,0.2619272823935271,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 26% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00387,0.2610049688295667,0,Medium,referral required but not present; claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim has a 26% estimated denial probability, mainly due to referral required but not present, claim has relatively high procedure/diagnosis complexity, and claim has a relatively high billed amount. Before submission, confirm that the required referral is present. This is a risk estimate, not a guarantee of denial."
CCLM-00193,0.2609969393425234,0,Medium,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 26% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00342,0.2584893080112053,0,Medium,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim has a 26% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, claim has a relatively high billed amount, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00289,0.2583647940625272,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 26% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00236,0.2582508765316513,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 26% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00340,0.2562327722758209,0,Medium,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim has a 26% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity, and visit type has elevated historical denial risk. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00336,0.25535204769588377,0,Medium,claim has relatively high procedure/diagnosis complexity,"This claim has a 26% estimated denial probability, mainly due to claim has relatively high procedure/diagnosis complexity. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00462,0.2526921775342341,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 25% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00119,0.2520751701250397,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 25% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00267,0.250322088406704,0,Medium,no major operational denial trigger is apparent from available fields,"This claim has a 25% estimated denial probability, mainly due to no major operational denial trigger is apparent from available fields. Before submission, route the claim for targeted analyst review. This is a risk estimate, not a guarantee of denial."
CCLM-00161,0.24804353565158777,0,Low,claim has a relatively high billed amount,"This claim is currently estimated as lower risk with a 25% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00274,0.24170692921438747,0,Low,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 24% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00123,0.24150938376069378,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 24% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00347,0.2408353016848861,0,Low,provider is out of network for the payer,"This claim is currently estimated as lower risk with a 24% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00084,0.23592900274451312,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 24% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00033,0.23538795503754506,0,Low,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 24% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00155,0.23519151580053904,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 24% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00300,0.23461153030432738,0,Low,claim has a relatively high billed amount,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00228,0.2345134388008598,0,Low,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00072,0.2344221619731784,0,Low,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00323,0.2333252948547077,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00198,0.2323955464864404,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00265,0.23179452005077883,0,Low,provider is out of network for the payer; claim has a relatively high billed amount,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00426,0.2295856380644216,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00078,0.22893601673065245,0,Low,claim has relatively high procedure/diagnosis complexity,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00056,0.22860275910849753,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00001,0.2281399123160334,0,Low,provider is out of network for the payer,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00167,0.2268398824707245,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00146,0.22635674474189443,0,Low,claim has a relatively high billed amount,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00357,0.2252320973866399,0,Low,provider is out of network for the payer,"This claim is currently estimated as lower risk with a 23% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00264,0.22480559146074258,0,Low,claim has relatively high procedure/diagnosis complexity,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00465,0.22281313319084442,0,Low,claim has a relatively high billed amount,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00041,0.22064982395859875,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00456,0.21971389404528305,0,Low,claim has a relatively high billed amount,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00406,0.21955984059149386,0,Low,claim has relatively high procedure/diagnosis complexity,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00425,0.21767854328773173,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00499,0.21592760851973508,0,Low,claim has relatively high procedure/diagnosis complexity,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00105,0.21554790903598028,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00327,0.21547021577546474,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 22% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00034,0.21417459846005107,0,Low,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00242,0.21297930883061733,0,Low,claim has relatively high procedure/diagnosis complexity,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00026,0.21183339467459228,0,Low,claim has relatively high procedure/diagnosis complexity,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00322,0.21061266070325022,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00208,0.21042750247578143,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00100,0.20951255443770048,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00485,0.20862601521668617,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00258,0.20851242180816051,0,Low,visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00356,0.20567175158947362,0,Low,claim has relatively high procedure/diagnosis complexity,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00093,0.2051644104909542,0,Low,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 21% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00175,0.20377744124572597,0,Low,provider is out of network for the payer; claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 20% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00029,0.2030637518260959,0,Low,provider is out of network for the payer,"This claim is currently estimated as lower risk with a 20% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00010,0.20093099252022487,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 20% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00186,0.19833366160319466,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 20% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00399,0.19694044927089177,0,Low,provider is out of network for the payer,"This claim is currently estimated as lower risk with a 20% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00361,0.1966044692213332,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 20% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00433,0.19654848093066216,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 20% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00303,0.19573406892418158,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 20% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00237,0.19487503471777462,0,Low,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 19% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00138,0.18986135696189643,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 19% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00244,0.18599825861778413,0,Low,claim has relatively high procedure/diagnosis complexity; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 19% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00358,0.18553752557473696,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 19% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00205,0.18434014788783024,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 18% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00415,0.18414587103037192,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 18% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00096,0.1837513883187773,0,Low,claim has relatively high procedure/diagnosis complexity; claim has a relatively high billed amount; visit type has elevated historical denial risk,"This claim is currently estimated as lower risk with a 18% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00232,0.17864284954853635,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 18% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00368,0.1749241413227206,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00427,0.17470816474881973,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00090,0.17382607375549256,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00482,0.1716118687674993,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00022,0.17062785622239193,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00284,0.16991379955605765,0,Low,claim has a relatively high billed amount,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00225,0.16915043652133624,0,Low,claim has relatively high procedure/diagnosis complexity,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00419,0.16871469967656352,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00273,0.1672380076327551,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00329,0.1654296770201661,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 17% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00445,0.16208290057306937,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 16% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00403,0.16141290380093443,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 16% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00153,0.1600381321081966,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 16% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00185,0.1555538371271253,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 16% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00250,0.14825627801652355,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 15% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00458,0.14465305237194412,0,Low,provider is out of network for the payer,"This claim is currently estimated as lower risk with a 14% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."
CCLM-00442,0.12368032008504572,0,Low,no major operational denial trigger is apparent from available fields,"This claim is currently estimated as lower risk with a 12% denial probability, and no major operational denial trigger is apparent from the available fields. Continue standard pre-submission checks. This is a risk estimate, not a guarantee of payment."