Extracted Information
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Payer & Administrative Details
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Payer Name:-
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Payer Address:-
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Date of Letter:-
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Level of Review:-
Member Information
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Member Name:-
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Member ID:-
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Date of Birth:-
Provider & Claim Information
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Provider Name:-
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Provider NPI:-
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Claim Number:-
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Requested Service:-
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HCPCS Code:-
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Coverage Determination:-
Denial & Policy Rationale
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Denial Reason(s):-
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Rationale Category:-
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Policy Reference:-
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Policy Review Date:-
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Sources Cited:-
Appeals & Review
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Appeal Window:-
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Appeal Options:-
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Appeal Timelines:-
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Reviewer Name:-
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Reviewer Role:-
Upload and analyze a denial letter to extract information
Claim Analysis
Payer Distribution
Insurance Coverage Types
Patient Demographics
Claim Status
Analysis Summary
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Risk Score Analysis
Risk Analysis Summary
Select a risk factor and analyze the scatter plot to see the risk score distribution.