Appeal review
Review queue
No appeal leaves this system without a decision recorded on this screen.
3 cases need a person 8 cases in the system
All of them are synthetic — an invented payer, generated charts — and they span 5 states of one pipeline. 3 of them are refusals: a case the system declined to argue, or a document it quarantined unread. A refusal here is the system working, not a gap in it.
- 2 waiting on you
- 0 waiting on a clinician
- 1 sent back to you
- 2 with the payer
- 3 closed
Show everything waiting on a person (3)
Start here
CASE-001 Verification rejected 2 drafts of this letter before one passed. The rejected drafts are on the case page in full, beside the objection that stopped each one — the shortest way to see what this system is for.
CASE-006 escalated itself to independent external review the moment its 30-day response window on the second-level appeal lapsed — a scheduler tick, no person in the loop. Worth opening to see what Lifecycle did unattended.
Closed cases (3)
These need nothing from anyone. They are listed because a case that simply disappears from the queue looks like a case that was lost.
- 2 Declined — no basis — No applicable policy, or the record did not support an honest argument. Nothing was drafted.
- 1 Quarantined — Screening found an injected instruction in the document. No agent read it.
Sent back to you
Show everything waiting on a person (3)
| Case | Patient | Service denied | Waiting on | Appeal deadline | Drafting attempts |
|---|---|---|---|---|---|
| CASE-003 | Creola Heller |
Magnetic resonance imaging, cardiac, with contrast material, including stress imaging and morphology
Sent back because: verification rejected all 3 drafting attempts |
Sent back for human review |
29 November 2026 30 days remaining |
3 (all 3 rejected by verification) |
|
Read by hand on 30 August 2026: two of those three rejections were wrong. Verification objected to a sentence that is the policy criterion word for word with “Requires that” in front of it, and to where “within the twelve months” attaches. The cap then fired on a sound appeal — a false positive, not the cap holding. docs/EVALUATION.md has the full reading. |
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