Interactive Sandbox Mode

RecoupOps Denial Recovery Workbench

Experience the live triage queue: parse remittances, review AI clinical appeal letters, approve packages, and track overturn resolution in real time.

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Showing 4 active sandbox claims
Active Denial Workqueue
CLM-94821AI Drafted
Robert T. (DOB 1968)
$4,850
14d left
UnitedHealthcareCO-19767% Overturn Prob
CLM-88302New Denial
Elena V. (DOB 1982)
$175
42d left
CenteneCO-5093% Overturn Prob
CLM-77219AI Drafted
Arthur M. (DOB 1955)
$6,200
6d left
CVS Health (Aetna)CO-9789% Overturn Prob
CLM-61943Approved
Maria G. (DOB 1974)
$1,950
28d left
Elevance HealthCO-1675% Overturn Prob
Clinical Appeal Workbench & Payer Package
CLM-94821 — UnitedHealthcareOrthopedic Surgery
Trigger: CO-197 — Precertification/Authorization absent
At-Risk Reimbursement
$4,850
Verified LCD/Regulatory Policy: CMS LCD-34981 (Arthroscopic Debridement Guidelines)
67% Overturn Benchmark
Generated Formal Clinical Dispute Letter
RE: Formal Dispute for Claim #CLM-94821. CPT 29881 was performed as an intraoperative necessity during authorized procedure CPT 29877. Enclosed operative notes confirm acute mechanical meniscus lock per LCD-34981 criteria...
Compiled Evidence Attachments:
Operative Chart Note
Original 835 Remit
LCD Coverage Exhibit
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Deterministic Audit Event Trail● Live Logging
12:04:12 - Ingested batch remit 835-2026-08-27.edi (4 denial lines)
12:04:14 - Model generated clinical appeal draft for Claim #CLM-94821 (67% overturn prob)
12:04:15 - Model generated clinical appeal draft for Claim #CLM-77219 (89% overturn prob)