adjudication_date string | appeal_final_resolution_state string | appeal_outcome string | appeal_round_number int64 | appeal_success_likelihood float64 | appeal_turnaround_days int64 | authorization_friction_score float64 | benchmark_bucket string | cash_flow_pressure_score float64 | claim_family string | claim_filing_indicator_code string | claim_form_type string | claim_frequency_code int64 | claim_id string | denial_adjustment_group_code string | denial_carc_code float64 | denial_probability float64 | denial_rarc_code string | denial_reason_family string | denial_scope string | diagnosis_codes string | documentation_completeness_band string | documentation_risk_score float64 | documentation_sensitivity string | economy_benefit_design_id string | economy_claim_intent_id string | economy_contract_id string | economy_expected_cash_impact_cents int64 | economy_expected_denial_reason_family string | economy_expected_underpayment_risk float64 | economy_policy_rule_id string | expected_payment_delay_days int64 | facility_claim_indicator bool | follow_up_visit_indicator bool | line_count int64 | member_id string | network_status string | out_of_network_leakage_score float64 | pack_id string | patient_responsibility_cents int64 | payer_archetype string | payer_behavior_score float64 | payer_id string | payer_region string | place_of_service string | preauth_required bool | primary_cpt_code int64 | primary_cpt_family string | procedure_authorization_status string | provider_id string | provider_specialty string | provider_taxonomy_code string | reimbursement_delay_risk float64 | scenario_label string | scenario_multiplier float64 | service_end_date string | service_region string | service_start_date string | site_of_service_category string | specialty_service_line string | submission_date string | submission_month string | total_allowed_cents int64 | total_billed_cents int64 | total_paid_cents int64 | type_of_bill_code float64 | world_ar_pressure_score float64 | world_auth_queue_depth int64 | world_benefit_design_id string | world_contract_id string | world_contract_method string | world_employer_plan_id string | world_id string | world_member_profile_id string | world_operations_state_id string | world_payer_profile_id string | world_policy_action string | world_policy_rule_id string | world_provider_panel_id string | world_region_id string | world_underpayment_probability float64 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2026-01-22 | paid | not_applicable | 0 | 0.26588 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5807 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000001 | null | null | 0.24015 | null | null | null | G56.00 | partial | 0.6346 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000001 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | true | 1 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,215 | office_eval | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-11 | gulf-south | 2026-01-10 | office | dermatologic | 2026-01-18 | 2026-01 | 92,020 | 127,805 | 92,020 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-03-01 | denied | upheld | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3777 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000002 | CO | 252 | 0.17075 | N706 | documentation | line | G43.909 | missing | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000002 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | true | 1 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 64,483 | procedure | expired | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-11 | north-texas | 2026-02-10 | asc | neurological | 2026-02-22 | 2026-02 | 250,263 | 347,587 | 0 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-26 | paid | not_applicable | 0 | 0.311695 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4659 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000003 | null | null | 0.20425 | null | null | null | K57.30 | complete | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000003 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | false | 2 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | office | true | 73,721 | diagnostic | not_required | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-14 | north-texas | 2026-03-13 | office | gastrointestinal | 2026-03-24 | 2026-03 | 593,330 | 824,070 | 593,330 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-04-29 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5515 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000004 | null | null | 0.22515 | null | null | null | L30.9 | complete | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000004 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | false | 2 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,214 | prior_auth_review | approved | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-14 | gulf-south | 2026-04-13 | asc | neurological | 2026-04-27 | 2026-04 | 308,798 | 428,886 | 308,798 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-05-26 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:office_eval | 0.3701 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000005 | null | null | 0.17075 | null | null | null | K57.30 | complete | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000005 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 21,781 | frequency_limit | 0.0602 | policy-specialty-clinic-payer-003-office_eval | 14 | false | true | 1 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.414 | specialty-clinic-payer-003 | gulf-south | office | true | 99,213 | office_eval | missing | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.3778 | baseline | 1 | 2026-05-19 | north-texas | 2026-05-14 | hospital_outpatient | dermatologic | 2026-05-21 | 2026-05 | 291,801 | 405,279 | 291,801 | null | 0.4973 | 20 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-05 | specialty-clinic-payer-003 | downcode_frequency_exceeded | policy-specialty-clinic-payer-003-office_eval | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-07-02 | paid | not_applicable | 0 | 0.303145 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:procedure | 0.4067 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000006 | null | null | 0.1955 | null | null | null | G43.909 | missing | 0.3664 | medium | specialty-clinic-benefit-standard | intent:specialty-clinic:000006 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 19,100 | frequency_limit | 0.0381 | policy-specialty-clinic-payer-001-procedure | 21 | false | true | 1 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5281 | specialty-clinic-payer-001 | mid-atlantic | office | true | 11,042 | procedure | not_required | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4667 | baseline | 1 | 2026-06-18 | mid-atlantic | 2026-06-14 | asc | dermatologic | 2026-06-30 | 2026-06 | 343,382 | 476,920 | 343,382 | null | 0.2432 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-05 | specialty-clinic-payer-001 | downcode_frequency_exceeded | policy-specialty-clinic-payer-001-procedure | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-07-30 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:diagnostic | 0.5745 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000007 | null | null | 0.22515 | null | null | null | G56.00 | complete | 0.3841 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000007 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 26,936 | frequency_limit | 0.2252 | policy-specialty-clinic-payer-002-diagnostic | 32 | false | false | 2 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6831 | specialty-clinic-payer-002 | mid-atlantic | office | true | 93,000 | diagnostic | missing | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7778 | baseline | 1 | 2026-07-19 | gulf-south | 2026-07-15 | office | musculoskeletal | 2026-07-23 | 2026-07 | 644,384 | 894,978 | 644,384 | null | 0.718 | 25 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-06 | specialty-clinic-payer-002 | request_attachment | policy-specialty-clinic-payer-002-diagnostic | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-09-03 | paid | not_applicable | 0 | 0.265096 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:prior_auth_review | 0.4146 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000008 | null | null | 0.18575 | null | null | null | L30.9 | missing | 0.5426 | high | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000008 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,550 | authorization | 0.1354 | policy-specialty-clinic-payer-003-prior_auth_review | 17 | false | false | 2 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4307 | specialty-clinic-payer-003 | gulf-south | office | true | 99,214 | prior_auth_review | not_required | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4444 | baseline | 1 | 2026-08-17 | north-texas | 2026-08-15 | asc | dermatologic | 2026-08-27 | 2026-08 | 552,894 | 767,908 | 552,894 | null | 0.1353 | 19 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-07 | specialty-clinic-payer-003 | require_authorization | policy-specialty-clinic-payer-003-prior_auth_review | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-09-28 | paid | not_applicable | 0 | 0.311695 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:office_eval | 0.4813 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000009 | null | null | 0.20425 | null | null | null | K57.30 | complete | 0.1752 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000009 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 27,125 | documentation | 0.2184 | policy-specialty-clinic-payer-001-office_eval | 24 | false | true | 2 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5614 | specialty-clinic-payer-001 | mid-atlantic | office | true | 99,214 | office_eval | not_required | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.6 | baseline | 1 | 2026-09-16 | north-texas | 2026-09-15 | asc | neurological | 2026-09-26 | 2026-09 | 389,603 | 541,115 | 389,603 | null | 0.6633 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-08 | specialty-clinic-payer-001 | deny_missing_documentation | policy-specialty-clinic-payer-001-office_eval | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-11-01 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:procedure | 0.5668 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000010 | null | null | 0.22515 | null | null | null | M54.50 | complete | 0.1837 | low | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000010 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 29,108 | frequency_limit | 0.2186 | policy-specialty-clinic-payer-002-procedure | 31 | false | true | 3 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6776 | specialty-clinic-payer-002 | mid-atlantic | hospital_outpatient | true | 20,610 | procedure | missing | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7556 | baseline | 1 | 2026-10-18 | gulf-south | 2026-10-16 | office | neurological | 2026-10-27 | 2026-10 | 1,025,588 | 1,424,428 | 1,025,588 | null | 0.86 | 20 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-09 | specialty-clinic-payer-002 | require_authorization | policy-specialty-clinic-payer-002-procedure | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-11-30 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:diagnostic | 0.3854 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000011 | null | null | 0.17075 | null | null | null | M17.11 | partial | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000011 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 23,656 | recoupment_risk | 0.1102 | policy-specialty-clinic-payer-003-diagnostic | 16 | false | true | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4251 | specialty-clinic-payer-003 | gulf-south | hospital_outpatient | true | 76,942 | diagnostic | missing | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.4222 | baseline | 1 | 2026-11-20 | north-texas | 2026-11-16 | asc | neurological | 2026-11-25 | 2026-11 | 404,929 | 562,402 | 404,929 | null | 0.4973 | 12 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-10 | specialty-clinic-payer-003 | recoup_post_payment_review | policy-specialty-clinic-payer-003-diagnostic | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-12-25 | paid | not_applicable | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:prior_auth_review | 0.4143 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000012 | null | null | 0.1955 | null | null | null | E03.9 | missing | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000012 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 21,225 | recoupment_risk | 0.0881 | policy-specialty-clinic-payer-001-prior_auth_review | 22 | false | true | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5337 | specialty-clinic-payer-001 | mid-atlantic | hospital_outpatient | true | 99,214 | prior_auth_review | expired | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4889 | baseline | 1 | 2026-12-05 | mid-atlantic | 2026-12-05 | office | musculoskeletal | 2026-12-18 | 2026-12 | 403,974 | 561,075 | 403,974 | null | 0.2432 | 8 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-11 | specialty-clinic-payer-001 | recoup_post_payment_review | policy-specialty-clinic-payer-001-prior_auth_review | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-01-23 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5592 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000013 | null | null | 0.22515 | null | null | null | K57.30 | partial | 0.1837 | low | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000013 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | true | 3 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,215 | office_eval | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-16 | gulf-south | 2026-01-10 | asc | dermatologic | 2026-01-18 | 2026-01 | 543,938 | 755,470 | 543,938 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-02-24 | paid | not_applicable | 0 | 0.265096 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3993 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000014 | null | null | 0.18575 | null | null | null | K21.9 | missing | 0.5426 | high | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000014 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | false | 3 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | office | true | 64,483 | procedure | approved | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-10 | north-texas | 2026-02-10 | asc | gastrointestinal | 2026-02-22 | 2026-02 | 816,998 | 1,134,720 | 816,998 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-31 | paid | not_applicable | 0 | 0.311695 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4659 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000015 | null | null | 0.20425 | null | null | null | E11.9 | missing | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000015 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | true | 3 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 73,721 | diagnostic | missing | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-14 | north-texas | 2026-03-13 | asc | dermatologic | 2026-03-24 | 2026-03 | 444,905 | 617,924 | 444,905 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-05-02 | paid | not_applicable | 0 | 0.26588 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5731 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000016 | null | null | 0.24015 | null | null | null | K21.9 | complete | 0.6346 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000016 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | true | 2 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | hospital_outpatient | true | 99,214 | prior_auth_review | expired | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-15 | gulf-south | 2026-04-13 | asc | gastrointestinal | 2026-04-27 | 2026-04 | 685,323 | 951,838 | 685,323 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-05-25 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:office_eval | 0.3701 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000017 | null | null | 0.17075 | null | null | null | E11.9 | partial | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000017 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 21,781 | frequency_limit | 0.0602 | policy-specialty-clinic-payer-003-office_eval | 14 | false | false | 3 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.414 | specialty-clinic-payer-003 | gulf-south | office | true | 99,213 | office_eval | missing | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.3778 | baseline | 1 | 2026-05-17 | north-texas | 2026-05-14 | asc | dermatologic | 2026-05-21 | 2026-05 | 724,355 | 1,006,049 | 724,355 | null | 0.4973 | 20 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-05 | specialty-clinic-payer-003 | downcode_frequency_exceeded | policy-specialty-clinic-payer-003-office_eval | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-07-07 | paid | not_applicable | 0 | 0.27474 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:procedure | 0.4283 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000018 | null | null | 0.2105 | null | null | null | M54.50 | missing | 0.6053 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000018 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 19,100 | frequency_limit | 0.0381 | policy-specialty-clinic-payer-001-procedure | 21 | false | true | 1 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5281 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 11,042 | procedure | missing | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4667 | baseline | 1 | 2026-06-20 | mid-atlantic | 2026-06-14 | hospital_outpatient | gastrointestinal | 2026-06-30 | 2026-06 | 141,150 | 196,042 | 141,150 | null | 0.2432 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-05 | specialty-clinic-payer-001 | downcode_frequency_exceeded | policy-specialty-clinic-payer-001-procedure | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-07-25 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:diagnostic | 0.5745 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000019 | null | null | 0.22515 | null | null | null | K57.30 | partial | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000019 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 26,936 | frequency_limit | 0.2252 | policy-specialty-clinic-payer-002-diagnostic | 32 | false | true | 2 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6831 | specialty-clinic-payer-002 | mid-atlantic | office | true | 93,000 | diagnostic | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7778 | baseline | 1 | 2026-07-22 | gulf-south | 2026-07-15 | hospital_outpatient | musculoskeletal | 2026-07-23 | 2026-07 | 418,689 | 581,513 | 418,689 | null | 0.718 | 25 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-06 | specialty-clinic-payer-002 | request_attachment | policy-specialty-clinic-payer-002-diagnostic | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-09-01 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:prior_auth_review | 0.393 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000020 | null | null | 0.17075 | null | null | null | M54.50 | complete | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000020 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,550 | authorization | 0.1354 | policy-specialty-clinic-payer-003-prior_auth_review | 17 | false | false | 1 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4307 | specialty-clinic-payer-003 | gulf-south | hospital_outpatient | true | 99,214 | prior_auth_review | not_required | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4444 | baseline | 1 | 2026-08-21 | north-texas | 2026-08-15 | office | dermatologic | 2026-08-27 | 2026-08 | 409,530 | 568,791 | 409,530 | null | 0.1353 | 19 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-07 | specialty-clinic-payer-003 | require_authorization | policy-specialty-clinic-payer-003-prior_auth_review | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-09-29 | paid | not_applicable | 0 | 0.268755 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:office_eval | 0.5029 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000021 | null | null | 0.21925 | null | null | null | M17.11 | missing | 0.6053 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000021 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 27,125 | documentation | 0.2184 | policy-specialty-clinic-payer-001-office_eval | 24 | false | false | 1 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5614 | specialty-clinic-payer-001 | mid-atlantic | hospital_outpatient | true | 99,214 | office_eval | missing | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.6 | baseline | 1 | 2026-09-22 | north-texas | 2026-09-15 | office | neurological | 2026-09-26 | 2026-09 | 69,811 | 96,960 | 69,811 | null | 0.6633 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-08 | specialty-clinic-payer-001 | deny_missing_documentation | policy-specialty-clinic-payer-001-office_eval | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-10-29 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:procedure | 0.5668 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000022 | null | null | 0.22515 | null | null | null | M54.50 | partial | 0.1837 | low | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000022 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 29,108 | frequency_limit | 0.2186 | policy-specialty-clinic-payer-002-procedure | 31 | false | false | 2 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6776 | specialty-clinic-payer-002 | mid-atlantic | ambulatory_surgery | true | 20,610 | procedure | not_required | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7556 | baseline | 1 | 2026-10-17 | gulf-south | 2026-10-16 | asc | dermatologic | 2026-10-27 | 2026-10 | 723,732 | 1,005,183 | 723,732 | null | 0.86 | 20 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-09 | specialty-clinic-payer-002 | require_authorization | policy-specialty-clinic-payer-002-procedure | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-11-29 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:diagnostic | 0.3854 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000023 | null | null | 0.17075 | null | null | null | G56.00 | missing | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000023 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 23,656 | recoupment_risk | 0.1102 | policy-specialty-clinic-payer-003-diagnostic | 16 | false | true | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4251 | specialty-clinic-payer-003 | gulf-south | office | true | 76,942 | diagnostic | expired | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.4222 | baseline | 1 | 2026-11-18 | north-texas | 2026-11-16 | hospital_outpatient | endocrine_metabolic | 2026-11-25 | 2026-11 | 722,981 | 1,004,140 | 722,981 | null | 0.4973 | 12 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-10 | specialty-clinic-payer-003 | recoup_post_payment_review | policy-specialty-clinic-payer-003-diagnostic | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-12-25 | denied | upheld | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:prior_auth_review | 0.4143 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000024 | CO | 11 | 0.1955 | N30 | coding | claim | K21.9 | partial | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000024 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 21,225 | recoupment_risk | 0.0881 | policy-specialty-clinic-payer-001-prior_auth_review | 22 | false | false | 3 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5337 | specialty-clinic-payer-001 | mid-atlantic | office | true | 99,214 | prior_auth_review | expired | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4889 | baseline | 1 | 2026-12-07 | mid-atlantic | 2026-12-05 | hospital_outpatient | endocrine_metabolic | 2026-12-18 | 2026-12 | 944,081 | 1,311,224 | 0 | null | 0.2432 | 8 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-11 | specialty-clinic-payer-001 | recoup_post_payment_review | policy-specialty-clinic-payer-001-prior_auth_review | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-01-20 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5592 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000025 | null | null | 0.22515 | null | null | null | K57.30 | complete | 0.3841 | medium | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000025 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | false | 3 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,215 | office_eval | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-16 | gulf-south | 2026-01-10 | office | gastrointestinal | 2026-01-18 | 2026-01 | 848,346 | 1,178,259 | 848,346 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-03-01 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3777 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000026 | null | null | 0.17075 | null | null | null | K21.9 | partial | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000026 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | true | 2 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | office | true | 64,483 | procedure | expired | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-12 | north-texas | 2026-02-10 | asc | neurological | 2026-02-22 | 2026-02 | 541,490 | 752,069 | 541,490 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-26 | paid | not_applicable | 0 | 0.29716 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4659 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000027 | null | null | 0.20425 | null | null | null | M17.11 | partial | 0.3664 | medium | specialty-clinic-benefit-standard | intent:specialty-clinic:000027 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | false | 1 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | hospital_outpatient | true | 73,721 | diagnostic | approved | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-16 | north-texas | 2026-03-13 | hospital_outpatient | musculoskeletal | 2026-03-24 | 2026-03 | 143,580 | 199,417 | 143,580 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-04-29 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5515 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000028 | null | null | 0.22515 | null | null | null | E03.9 | missing | 0.3841 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000028 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | true | 2 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | ambulatory_surgery | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-13 | gulf-south | 2026-04-13 | asc | musculoskeletal | 2026-04-27 | 2026-04 | 404,885 | 562,340 | 404,885 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-05-27 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:office_eval | 0.3701 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000029 | null | null | 0.17075 | null | null | null | M17.11 | missing | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000029 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 21,781 | frequency_limit | 0.0602 | policy-specialty-clinic-payer-003-office_eval | 14 | false | false | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.414 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 99,213 | office_eval | approved | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.3778 | baseline | 1 | 2026-05-17 | north-texas | 2026-05-14 | hospital_outpatient | neurological | 2026-05-21 | 2026-05 | 829,436 | 1,151,994 | 829,436 | null | 0.4973 | 20 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-05 | specialty-clinic-payer-003 | downcode_frequency_exceeded | policy-specialty-clinic-payer-003-office_eval | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-07-04 | paid | not_applicable | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:procedure | 0.4067 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000030 | null | null | 0.1955 | null | null | null | K21.9 | partial | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000030 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 19,100 | frequency_limit | 0.0381 | policy-specialty-clinic-payer-001-procedure | 21 | false | true | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5281 | specialty-clinic-payer-001 | mid-atlantic | office | true | 11,042 | procedure | approved | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4667 | baseline | 1 | 2026-06-20 | mid-atlantic | 2026-06-14 | asc | endocrine_metabolic | 2026-06-30 | 2026-06 | 143,491 | 199,293 | 143,491 | null | 0.2432 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-05 | specialty-clinic-payer-001 | downcode_frequency_exceeded | policy-specialty-clinic-payer-001-procedure | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-07-30 | paid | not_applicable | 0 | 0.26588 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:diagnostic | 0.5961 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000031 | null | null | 0.24015 | null | null | null | D48.5 | missing | 0.6346 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000031 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 26,936 | frequency_limit | 0.2252 | policy-specialty-clinic-payer-002-diagnostic | 32 | false | true | 2 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6831 | specialty-clinic-payer-002 | mid-atlantic | office | true | 93,000 | diagnostic | missing | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7778 | baseline | 1 | 2026-07-15 | gulf-south | 2026-07-15 | asc | neurological | 2026-07-23 | 2026-07 | 164,357 | 228,273 | 164,357 | null | 0.718 | 25 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-06 | specialty-clinic-payer-002 | request_attachment | policy-specialty-clinic-payer-002-diagnostic | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-09-03 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:prior_auth_review | 0.393 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000032 | null | null | 0.17075 | null | null | null | M54.50 | complete | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000032 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,550 | authorization | 0.1354 | policy-specialty-clinic-payer-003-prior_auth_review | 17 | false | true | 1 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4307 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 99,214 | prior_auth_review | expired | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4444 | baseline | 1 | 2026-08-16 | north-texas | 2026-08-15 | hospital_outpatient | endocrine_metabolic | 2026-08-27 | 2026-08 | 142,008 | 197,234 | 142,008 | null | 0.1353 | 19 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-07 | specialty-clinic-payer-003 | require_authorization | policy-specialty-clinic-payer-003-prior_auth_review | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-10-03 | paid | not_applicable | 0 | 0.29716 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:office_eval | 0.4813 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000033 | null | null | 0.20425 | null | null | null | E11.9 | complete | 0.3664 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000033 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 27,125 | documentation | 0.2184 | policy-specialty-clinic-payer-001-office_eval | 24 | false | true | 1 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5614 | specialty-clinic-payer-001 | mid-atlantic | office | true | 99,214 | office_eval | not_required | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.6 | baseline | 1 | 2026-09-22 | north-texas | 2026-09-15 | asc | neurological | 2026-09-26 | 2026-09 | 217,042 | 301,447 | 217,042 | null | 0.6633 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-08 | specialty-clinic-payer-001 | deny_missing_documentation | policy-specialty-clinic-payer-001-office_eval | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-10-31 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:procedure | 0.5668 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000034 | null | null | 0.22515 | null | null | null | M54.50 | missing | 0.3841 | medium | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000034 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 29,108 | frequency_limit | 0.2186 | policy-specialty-clinic-payer-002-procedure | 31 | false | true | 2 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6776 | specialty-clinic-payer-002 | mid-atlantic | office | true | 20,610 | procedure | approved | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7556 | baseline | 1 | 2026-10-21 | gulf-south | 2026-10-16 | asc | musculoskeletal | 2026-10-27 | 2026-10 | 663,414 | 921,409 | 663,414 | null | 0.86 | 20 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-09 | specialty-clinic-payer-002 | require_authorization | policy-specialty-clinic-payer-002-procedure | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-11-30 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:diagnostic | 0.3854 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000035 | null | null | 0.17075 | null | null | null | M17.11 | partial | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000035 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 23,656 | recoupment_risk | 0.1102 | policy-specialty-clinic-payer-003-diagnostic | 16 | false | false | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4251 | specialty-clinic-payer-003 | gulf-south | office | true | 76,942 | diagnostic | approved | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.4222 | baseline | 1 | 2026-11-21 | north-texas | 2026-11-16 | office | endocrine_metabolic | 2026-11-25 | 2026-11 | 248,363 | 344,949 | 248,363 | null | 0.4973 | 12 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-10 | specialty-clinic-payer-003 | recoup_post_payment_review | policy-specialty-clinic-payer-003-diagnostic | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-12-20 | paid | not_applicable | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:prior_auth_review | 0.4143 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000036 | null | null | 0.1955 | null | null | null | E03.9 | complete | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000036 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 21,225 | recoupment_risk | 0.0881 | policy-specialty-clinic-payer-001-prior_auth_review | 22 | false | true | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5337 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 99,214 | prior_auth_review | not_required | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4889 | baseline | 1 | 2026-12-10 | mid-atlantic | 2026-12-05 | hospital_outpatient | gastrointestinal | 2026-12-18 | 2026-12 | 493,625 | 685,590 | 493,625 | null | 0.2432 | 8 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-11 | specialty-clinic-payer-001 | recoup_post_payment_review | policy-specialty-clinic-payer-001-prior_auth_review | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-01-24 | denied | upheld | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5592 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000037 | CO | 252 | 0.22515 | N706 | documentation | line | K57.30 | complete | 0.1837 | low | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000037 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | false | 3 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,215 | office_eval | approved | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-12 | gulf-south | 2026-01-10 | asc | musculoskeletal | 2026-01-18 | 2026-01 | 1,194,868 | 1,659,539 | 0 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-02-24 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3777 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000038 | null | null | 0.17075 | null | null | null | G43.909 | partial | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000038 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | true | 2 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 64,483 | procedure | approved | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-10 | north-texas | 2026-02-10 | office | endocrine_metabolic | 2026-02-22 | 2026-02 | 304,559 | 422,999 | 304,559 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-27 | partially_paid | partially_overturned | 1 | 0.29716 | 19 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4659 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000039 | CO | 50 | 0.20425 | N115 | medical-necessity | claim | E11.9 | partial | 0.3664 | medium | specialty-clinic-benefit-standard | intent:specialty-clinic:000039 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | true | 2 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | office | true | 73,721 | diagnostic | missing | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-14 | north-texas | 2026-03-13 | office | musculoskeletal | 2026-03-24 | 2026-03 | 488,651 | 678,682 | 219,893 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-05-01 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5515 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000040 | null | null | 0.22515 | null | null | null | E03.9 | partial | 0.3841 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000040 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | true | 2 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,214 | prior_auth_review | expired | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-19 | gulf-south | 2026-04-13 | asc | gastrointestinal | 2026-04-27 | 2026-04 | 575,839 | 799,777 | 575,839 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-05-26 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:office_eval | 0.3701 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000041 | null | null | 0.17075 | null | null | null | M17.11 | complete | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000041 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 21,781 | frequency_limit | 0.0602 | policy-specialty-clinic-payer-003-office_eval | 14 | false | false | 1 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.414 | specialty-clinic-payer-003 | gulf-south | office | true | 99,213 | office_eval | approved | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.3778 | baseline | 1 | 2026-05-20 | north-texas | 2026-05-14 | asc | musculoskeletal | 2026-05-21 | 2026-05 | 147,104 | 204,311 | 147,104 | null | 0.4973 | 20 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-05 | specialty-clinic-payer-003 | downcode_frequency_exceeded | policy-specialty-clinic-payer-003-office_eval | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-07-02 | paid | not_applicable | 0 | 0.303145 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:procedure | 0.4067 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000042 | null | null | 0.1955 | null | null | null | E03.9 | missing | 0.3664 | medium | specialty-clinic-benefit-standard | intent:specialty-clinic:000042 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 19,100 | frequency_limit | 0.0381 | policy-specialty-clinic-payer-001-procedure | 21 | false | true | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5281 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 11,042 | procedure | missing | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4667 | baseline | 1 | 2026-06-14 | mid-atlantic | 2026-06-14 | hospital_outpatient | neurological | 2026-06-30 | 2026-06 | 313,544 | 435,478 | 313,544 | null | 0.2432 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-05 | specialty-clinic-payer-001 | downcode_frequency_exceeded | policy-specialty-clinic-payer-001-procedure | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-07-27 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:diagnostic | 0.5745 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000043 | null | null | 0.22515 | null | null | null | G56.00 | partial | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000043 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 26,936 | frequency_limit | 0.2252 | policy-specialty-clinic-payer-002-diagnostic | 32 | false | false | 2 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6831 | specialty-clinic-payer-002 | mid-atlantic | office | true | 93,000 | diagnostic | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7778 | baseline | 1 | 2026-07-15 | gulf-south | 2026-07-15 | office | dermatologic | 2026-07-23 | 2026-07 | 383,705 | 532,923 | 383,705 | null | 0.718 | 25 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-06 | specialty-clinic-payer-002 | request_attachment | policy-specialty-clinic-payer-002-diagnostic | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-09-01 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:prior_auth_review | 0.393 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000044 | null | null | 0.17075 | null | null | null | M54.50 | partial | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000044 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,550 | authorization | 0.1354 | policy-specialty-clinic-payer-003-prior_auth_review | 17 | false | true | 3 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4307 | specialty-clinic-payer-003 | gulf-south | office | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4444 | baseline | 1 | 2026-08-21 | north-texas | 2026-08-15 | office | neurological | 2026-08-27 | 2026-08 | 642,458 | 892,303 | 642,458 | null | 0.1353 | 19 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-07 | specialty-clinic-payer-003 | require_authorization | policy-specialty-clinic-payer-003-prior_auth_review | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-09-28 | paid | not_applicable | 0 | 0.29716 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:office_eval | 0.4813 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000045 | null | null | 0.20425 | null | null | null | M17.11 | partial | 0.3664 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000045 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 27,125 | documentation | 0.2184 | policy-specialty-clinic-payer-001-office_eval | 24 | false | true | 1 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5614 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 99,214 | office_eval | approved | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.6 | baseline | 1 | 2026-09-20 | north-texas | 2026-09-15 | asc | musculoskeletal | 2026-09-26 | 2026-09 | 239,933 | 333,240 | 239,933 | null | 0.6633 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-08 | specialty-clinic-payer-001 | deny_missing_documentation | policy-specialty-clinic-payer-001-office_eval | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-11-02 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:procedure | 0.5668 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000046 | null | null | 0.22515 | null | null | null | E03.9 | missing | 0.1837 | low | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000046 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 29,108 | frequency_limit | 0.2186 | policy-specialty-clinic-payer-002-procedure | 31 | false | false | 2 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6776 | specialty-clinic-payer-002 | mid-atlantic | hospital_outpatient | true | 20,610 | procedure | missing | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7556 | baseline | 1 | 2026-10-18 | gulf-south | 2026-10-16 | hospital_outpatient | gastrointestinal | 2026-10-27 | 2026-10 | 458,765 | 637,174 | 458,765 | null | 0.86 | 20 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-09 | specialty-clinic-payer-002 | require_authorization | policy-specialty-clinic-payer-002-procedure | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-12-01 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:diagnostic | 0.3854 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000047 | null | null | 0.17075 | null | null | null | E11.9 | complete | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000047 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 23,656 | recoupment_risk | 0.1102 | policy-specialty-clinic-payer-003-diagnostic | 16 | false | false | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4251 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 76,942 | diagnostic | not_required | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.4222 | baseline | 1 | 2026-11-23 | north-texas | 2026-11-16 | hospital_outpatient | gastrointestinal | 2026-11-25 | 2026-11 | 676,291 | 939,293 | 676,291 | null | 0.4973 | 12 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-10 | specialty-clinic-payer-003 | recoup_post_payment_review | policy-specialty-clinic-payer-003-diagnostic | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-12-24 | paid | not_applicable | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:prior_auth_review | 0.4143 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000048 | null | null | 0.1955 | null | null | null | M54.50 | partial | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000048 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 21,225 | recoupment_risk | 0.0881 | policy-specialty-clinic-payer-001-prior_auth_review | 22 | false | true | 1 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5337 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 99,214 | prior_auth_review | expired | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4889 | baseline | 1 | 2026-12-06 | mid-atlantic | 2026-12-05 | asc | neurological | 2026-12-18 | 2026-12 | 258,255 | 358,687 | 258,255 | null | 0.2432 | 8 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-11 | specialty-clinic-payer-001 | recoup_post_payment_review | policy-specialty-clinic-payer-001-prior_auth_review | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-01-20 | paid | not_applicable | 0 | 0.26588 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5807 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000049 | null | null | 0.24015 | null | null | null | G56.00 | missing | 0.6346 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000049 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | false | 1 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,215 | office_eval | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-14 | gulf-south | 2026-01-10 | hospital_outpatient | musculoskeletal | 2026-01-18 | 2026-01 | 106,352 | 147,711 | 106,352 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-02-26 | paid | not_applicable | 0 | 0.265096 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3993 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000050 | null | null | 0.18575 | null | null | null | M54.50 | partial | 0.5426 | high | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000050 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | true | 3 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | office | true | 64,483 | procedure | approved | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-11 | north-texas | 2026-02-10 | asc | neurological | 2026-02-22 | 2026-02 | 478,316 | 664,328 | 478,316 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-28 | paid | not_applicable | 0 | 0.311695 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4659 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000051 | null | null | 0.20425 | null | null | null | D48.5 | missing | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000051 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | true | 2 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | office | true | 73,721 | diagnostic | not_required | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-14 | north-texas | 2026-03-13 | hospital_outpatient | gastrointestinal | 2026-03-24 | 2026-03 | 347,905 | 483,202 | 347,905 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-04-30 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5515 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000052 | null | null | 0.22515 | null | null | null | K21.9 | complete | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000052 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | true | 1 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-16 | gulf-south | 2026-04-13 | office | musculoskeletal | 2026-04-27 | 2026-04 | 35,225 | 48,923 | 35,225 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-05-23 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:office_eval | 0.3701 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000053 | null | null | 0.17075 | null | null | null | M17.11 | missing | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000053 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 21,781 | frequency_limit | 0.0602 | policy-specialty-clinic-payer-003-office_eval | 14 | false | false | 1 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.414 | specialty-clinic-payer-003 | gulf-south | office | true | 99,213 | office_eval | not_required | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.3778 | baseline | 1 | 2026-05-15 | north-texas | 2026-05-14 | hospital_outpatient | dermatologic | 2026-05-21 | 2026-05 | 15,565 | 21,618 | 15,565 | null | 0.4973 | 20 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-05 | specialty-clinic-payer-003 | downcode_frequency_exceeded | policy-specialty-clinic-payer-003-office_eval | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-07-06 | paid | not_applicable | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:procedure | 0.4067 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000054 | null | null | 0.1955 | null | null | null | K21.9 | complete | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000054 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 19,100 | frequency_limit | 0.0381 | policy-specialty-clinic-payer-001-procedure | 21 | false | false | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5281 | specialty-clinic-payer-001 | mid-atlantic | office | true | 11,042 | procedure | approved | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4667 | baseline | 1 | 2026-06-19 | mid-atlantic | 2026-06-14 | office | musculoskeletal | 2026-06-30 | 2026-06 | 623,727 | 866,288 | 623,727 | null | 0.2432 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-05 | specialty-clinic-payer-001 | downcode_frequency_exceeded | policy-specialty-clinic-payer-001-procedure | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-07-29 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:diagnostic | 0.5745 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000055 | null | null | 0.22515 | null | null | null | M17.11 | complete | 0.3841 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000055 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 26,936 | frequency_limit | 0.2252 | policy-specialty-clinic-payer-002-diagnostic | 32 | false | true | 1 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6831 | specialty-clinic-payer-002 | mid-atlantic | ambulatory_surgery | true | 93,000 | diagnostic | approved | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7778 | baseline | 1 | 2026-07-20 | gulf-south | 2026-07-15 | hospital_outpatient | endocrine_metabolic | 2026-07-23 | 2026-07 | 93,548 | 129,928 | 93,548 | null | 0.718 | 25 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-06 | specialty-clinic-payer-002 | request_attachment | policy-specialty-clinic-payer-002-diagnostic | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-09-03 | paid | not_applicable | 0 | 0.265096 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:prior_auth_review | 0.4146 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000056 | null | null | 0.18575 | null | null | null | G43.909 | missing | 0.5426 | high | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000056 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,550 | authorization | 0.1354 | policy-specialty-clinic-payer-003-prior_auth_review | 17 | false | false | 3 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4307 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4444 | baseline | 1 | 2026-08-15 | north-texas | 2026-08-15 | asc | endocrine_metabolic | 2026-08-27 | 2026-08 | 449,247 | 623,954 | 449,247 | null | 0.1353 | 19 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-07 | specialty-clinic-payer-003 | require_authorization | policy-specialty-clinic-payer-003-prior_auth_review | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-09-29 | paid | overturned | 1 | 0.29716 | 23 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:office_eval | 0.4813 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000057 | CO | 197 | 0.20425 | N130 | authorization | claim | D48.5 | complete | 0.3664 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000057 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 27,125 | documentation | 0.2184 | policy-specialty-clinic-payer-001-office_eval | 24 | false | false | 1 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5614 | specialty-clinic-payer-001 | mid-atlantic | office | true | 99,214 | office_eval | approved | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.6 | baseline | 1 | 2026-09-18 | north-texas | 2026-09-15 | hospital_outpatient | endocrine_metabolic | 2026-09-26 | 2026-09 | 295,415 | 410,298 | 295,415 | null | 0.6633 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-08 | specialty-clinic-payer-001 | deny_missing_documentation | policy-specialty-clinic-payer-001-office_eval | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-10-30 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:procedure | 0.5668 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000058 | null | null | 0.22515 | null | null | null | G43.909 | partial | 0.1837 | low | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000058 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 29,108 | frequency_limit | 0.2186 | policy-specialty-clinic-payer-002-procedure | 31 | false | false | 3 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6776 | specialty-clinic-payer-002 | mid-atlantic | office | true | 20,610 | procedure | expired | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7556 | baseline | 1 | 2026-10-18 | gulf-south | 2026-10-16 | hospital_outpatient | neurological | 2026-10-27 | 2026-10 | 626,668 | 870,372 | 626,668 | null | 0.86 | 20 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-09 | specialty-clinic-payer-002 | require_authorization | policy-specialty-clinic-payer-002-procedure | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-11-30 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:diagnostic | 0.3854 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000059 | null | null | 0.17075 | null | null | null | G56.00 | partial | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000059 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 23,656 | recoupment_risk | 0.1102 | policy-specialty-clinic-payer-003-diagnostic | 16 | false | true | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4251 | specialty-clinic-payer-003 | gulf-south | office | true | 76,942 | diagnostic | expired | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.4222 | baseline | 1 | 2026-11-20 | north-texas | 2026-11-16 | office | endocrine_metabolic | 2026-11-25 | 2026-11 | 566,353 | 786,602 | 566,353 | null | 0.4973 | 12 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-10 | specialty-clinic-payer-003 | recoup_post_payment_review | policy-specialty-clinic-payer-003-diagnostic | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-12-20 | paid | not_applicable | 0 | 0.27474 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:prior_auth_review | 0.4359 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000060 | null | null | 0.2105 | null | null | null | M54.50 | partial | 0.6053 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000060 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 21,225 | recoupment_risk | 0.0881 | policy-specialty-clinic-payer-001-prior_auth_review | 22 | false | true | 3 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5337 | specialty-clinic-payer-001 | mid-atlantic | office | true | 99,214 | prior_auth_review | expired | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4889 | baseline | 1 | 2026-12-09 | mid-atlantic | 2026-12-05 | asc | neurological | 2026-12-18 | 2026-12 | 584,286 | 811,508 | 584,286 | null | 0.2432 | 8 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-11 | specialty-clinic-payer-001 | recoup_post_payment_review | policy-specialty-clinic-payer-001-prior_auth_review | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-01-21 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5592 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000061 | null | null | 0.22515 | null | null | null | K57.30 | complete | 0.3841 | medium | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000061 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | true | 3 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,215 | office_eval | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-17 | gulf-south | 2026-01-10 | asc | neurological | 2026-01-18 | 2026-01 | 696,201 | 966,946 | 696,201 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-02-26 | denied | upheld | 0 | 0.265096 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3993 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000062 | CO | 50 | 0.18575 | N115 | medical-necessity | line | E03.9 | complete | 0.5426 | high | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000062 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | false | 1 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 64,483 | procedure | missing | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-10 | north-texas | 2026-02-10 | office | endocrine_metabolic | 2026-02-22 | 2026-02 | 85,781 | 119,140 | 0 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-27 | paid | not_applicable | 0 | 0.29716 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4659 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000063 | null | null | 0.20425 | null | null | null | M17.11 | complete | 0.3664 | medium | specialty-clinic-benefit-standard | intent:specialty-clinic:000063 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | false | 3 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | office | true | 73,721 | diagnostic | missing | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-20 | north-texas | 2026-03-13 | hospital_outpatient | neurological | 2026-03-24 | 2026-03 | 1,130,222 | 1,569,753 | 1,130,222 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-05-04 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5515 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000064 | null | null | 0.22515 | null | null | null | L30.9 | complete | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000064 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | false | 1 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-18 | gulf-south | 2026-04-13 | office | gastrointestinal | 2026-04-27 | 2026-04 | 219,599 | 304,998 | 219,599 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-05-27 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:office_eval | 0.3701 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000065 | null | null | 0.17075 | null | null | null | G56.00 | partial | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000065 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 21,781 | frequency_limit | 0.0602 | policy-specialty-clinic-payer-003-office_eval | 14 | false | false | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.414 | specialty-clinic-payer-003 | gulf-south | office | true | 99,213 | office_eval | missing | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.3778 | baseline | 1 | 2026-05-16 | north-texas | 2026-05-14 | hospital_outpatient | dermatologic | 2026-05-21 | 2026-05 | 407,559 | 566,054 | 407,559 | null | 0.4973 | 20 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-05 | specialty-clinic-payer-003 | downcode_frequency_exceeded | policy-specialty-clinic-payer-003-office_eval | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-07-06 | paid | not_applicable | 0 | 0.27474 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:procedure | 0.4283 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000066 | null | null | 0.2105 | null | null | null | E03.9 | partial | 0.6053 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000066 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 19,100 | frequency_limit | 0.0381 | policy-specialty-clinic-payer-001-procedure | 21 | false | true | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5281 | specialty-clinic-payer-001 | mid-atlantic | office | true | 11,042 | procedure | not_required | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4667 | baseline | 1 | 2026-06-20 | mid-atlantic | 2026-06-14 | hospital_outpatient | neurological | 2026-06-30 | 2026-06 | 415,534 | 577,130 | 415,534 | null | 0.2432 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-05 | specialty-clinic-payer-001 | downcode_frequency_exceeded | policy-specialty-clinic-payer-001-procedure | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-07-25 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:diagnostic | 0.5745 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000067 | null | null | 0.22515 | null | null | null | K57.30 | complete | 0.3841 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000067 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 26,936 | frequency_limit | 0.2252 | policy-specialty-clinic-payer-002-diagnostic | 32 | false | true | 3 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6831 | specialty-clinic-payer-002 | mid-atlantic | office | true | 93,000 | diagnostic | approved | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7778 | baseline | 1 | 2026-07-15 | gulf-south | 2026-07-15 | office | endocrine_metabolic | 2026-07-23 | 2026-07 | 427,096 | 593,189 | 427,096 | null | 0.718 | 25 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-06 | specialty-clinic-payer-002 | request_attachment | policy-specialty-clinic-payer-002-diagnostic | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-09-03 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:prior_auth_review | 0.393 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000068 | null | null | 0.17075 | null | null | null | L30.9 | missing | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000068 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,550 | authorization | 0.1354 | policy-specialty-clinic-payer-003-prior_auth_review | 17 | false | false | 2 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4307 | specialty-clinic-payer-003 | gulf-south | office | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4444 | baseline | 1 | 2026-08-17 | north-texas | 2026-08-15 | hospital_outpatient | endocrine_metabolic | 2026-08-27 | 2026-08 | 669,736 | 930,189 | 669,736 | null | 0.1353 | 19 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-07 | specialty-clinic-payer-003 | require_authorization | policy-specialty-clinic-payer-003-prior_auth_review | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-09-28 | denied | upheld | 0 | 0.29716 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:office_eval | 0.4813 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000069 | CO | 50 | 0.20425 | N115 | medical-necessity | line | D48.5 | complete | 0.3664 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000069 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 27,125 | documentation | 0.2184 | policy-specialty-clinic-payer-001-office_eval | 24 | false | false | 3 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5614 | specialty-clinic-payer-001 | mid-atlantic | office | true | 99,214 | office_eval | expired | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.6 | baseline | 1 | 2026-09-16 | north-texas | 2026-09-15 | asc | musculoskeletal | 2026-09-26 | 2026-09 | 483,947 | 672,148 | 0 | null | 0.6633 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-08 | specialty-clinic-payer-001 | deny_missing_documentation | policy-specialty-clinic-payer-001-office_eval | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-11-02 | denied | upheld | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:procedure | 0.5668 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000070 | CO | 252 | 0.22515 | N706 | documentation | claim | M54.50 | complete | 0.3841 | medium | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000070 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 29,108 | frequency_limit | 0.2186 | policy-specialty-clinic-payer-002-procedure | 31 | false | true | 1 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6776 | specialty-clinic-payer-002 | mid-atlantic | office | true | 20,610 | procedure | expired | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7556 | baseline | 1 | 2026-10-19 | gulf-south | 2026-10-16 | hospital_outpatient | gastrointestinal | 2026-10-27 | 2026-10 | 299,288 | 415,678 | 0 | null | 0.86 | 20 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-09 | specialty-clinic-payer-002 | require_authorization | policy-specialty-clinic-payer-002-procedure | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-11-29 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:diagnostic | 0.3854 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000071 | null | null | 0.17075 | null | null | null | K57.30 | partial | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000071 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 23,656 | recoupment_risk | 0.1102 | policy-specialty-clinic-payer-003-diagnostic | 16 | false | true | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4251 | specialty-clinic-payer-003 | gulf-south | office | true | 76,942 | diagnostic | expired | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.4222 | baseline | 1 | 2026-11-20 | north-texas | 2026-11-16 | office | neurological | 2026-11-25 | 2026-11 | 809,796 | 1,124,717 | 809,796 | null | 0.4973 | 12 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-10 | specialty-clinic-payer-003 | recoup_post_payment_review | policy-specialty-clinic-payer-003-diagnostic | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-12-21 | paid | not_applicable | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:prior_auth_review | 0.4143 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000072 | null | null | 0.1955 | null | null | null | M54.50 | complete | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000072 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 21,225 | recoupment_risk | 0.0881 | policy-specialty-clinic-payer-001-prior_auth_review | 22 | false | true | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5337 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4889 | baseline | 1 | 2026-12-08 | mid-atlantic | 2026-12-05 | asc | dermatologic | 2026-12-18 | 2026-12 | 467,096 | 648,745 | 467,096 | null | 0.2432 | 8 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-11 | specialty-clinic-payer-001 | recoup_post_payment_review | policy-specialty-clinic-payer-001-prior_auth_review | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-01-21 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5592 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000073 | null | null | 0.22515 | null | null | null | G56.00 | complete | 0.3841 | medium | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000073 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | true | 3 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | ambulatory_surgery | true | 99,215 | office_eval | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-15 | gulf-south | 2026-01-10 | hospital_outpatient | musculoskeletal | 2026-01-18 | 2026-01 | 977,636 | 1,357,828 | 977,636 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-02-27 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3777 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000074 | null | null | 0.17075 | null | null | null | M54.50 | partial | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000074 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | false | 1 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | office | true | 64,483 | procedure | not_required | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-11 | north-texas | 2026-02-10 | asc | endocrine_metabolic | 2026-02-22 | 2026-02 | 292,775 | 406,632 | 292,775 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-31 | paid | not_applicable | 0 | 0.29716 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4659 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000075 | null | null | 0.20425 | null | null | null | K57.30 | partial | 0.3664 | medium | specialty-clinic-benefit-standard | intent:specialty-clinic:000075 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | true | 3 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | office | true | 73,721 | diagnostic | approved | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-14 | north-texas | 2026-03-13 | asc | endocrine_metabolic | 2026-03-24 | 2026-03 | 665,509 | 924,318 | 665,509 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-05-04 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5515 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000076 | null | null | 0.22515 | null | null | null | K21.9 | complete | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000076 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | false | 1 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | hospital_outpatient | true | 99,214 | prior_auth_review | not_required | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-19 | gulf-south | 2026-04-13 | hospital_outpatient | musculoskeletal | 2026-04-27 | 2026-04 | 324,247 | 450,343 | 324,247 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-05-24 | denied | upheld | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:office_eval | 0.3701 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000077 | CO | 252 | 0.17075 | N706 | documentation | claim | D48.5 | missing | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000077 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 21,781 | frequency_limit | 0.0602 | policy-specialty-clinic-payer-003-office_eval | 14 | false | true | 3 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.414 | specialty-clinic-payer-003 | gulf-south | office | true | 99,213 | office_eval | approved | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.3778 | baseline | 1 | 2026-05-16 | north-texas | 2026-05-14 | office | dermatologic | 2026-05-21 | 2026-05 | 964,709 | 1,339,873 | 0 | null | 0.4973 | 20 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-05 | specialty-clinic-payer-003 | downcode_frequency_exceeded | policy-specialty-clinic-payer-003-office_eval | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-07-06 | paid | not_applicable | 0 | 0.303145 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:procedure | 0.4067 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000078 | null | null | 0.1955 | null | null | null | E03.9 | partial | 0.3664 | medium | specialty-clinic-benefit-standard | intent:specialty-clinic:000078 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 19,100 | frequency_limit | 0.0381 | policy-specialty-clinic-payer-001-procedure | 21 | false | false | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5281 | specialty-clinic-payer-001 | mid-atlantic | office | true | 11,042 | procedure | missing | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4667 | baseline | 1 | 2026-06-14 | mid-atlantic | 2026-06-14 | asc | musculoskeletal | 2026-06-30 | 2026-06 | 253,513 | 352,102 | 253,513 | null | 0.2432 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-05 | specialty-clinic-payer-001 | downcode_frequency_exceeded | policy-specialty-clinic-payer-001-procedure | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-07-29 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:diagnostic | 0.5745 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000079 | null | null | 0.22515 | null | null | null | K57.30 | complete | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000079 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 26,936 | frequency_limit | 0.2252 | policy-specialty-clinic-payer-002-diagnostic | 32 | false | false | 1 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6831 | specialty-clinic-payer-002 | mid-atlantic | office | true | 93,000 | diagnostic | approved | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7778 | baseline | 1 | 2026-07-18 | gulf-south | 2026-07-15 | office | gastrointestinal | 2026-07-23 | 2026-07 | 212,817 | 295,579 | 212,817 | null | 0.718 | 25 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-06 | specialty-clinic-payer-002 | request_attachment | policy-specialty-clinic-payer-002-diagnostic | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-08-29 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:prior_auth_review | 0.393 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000080 | null | null | 0.17075 | null | null | null | G43.909 | complete | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000080 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,550 | authorization | 0.1354 | policy-specialty-clinic-payer-003-prior_auth_review | 17 | false | true | 1 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4307 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4444 | baseline | 1 | 2026-08-19 | north-texas | 2026-08-15 | hospital_outpatient | gastrointestinal | 2026-08-27 | 2026-08 | 419,561 | 582,723 | 419,561 | null | 0.1353 | 19 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-07 | specialty-clinic-payer-003 | require_authorization | policy-specialty-clinic-payer-003-prior_auth_review | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-09-30 | paid | not_applicable | 0 | 0.29716 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:office_eval | 0.4813 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000081 | null | null | 0.20425 | null | null | null | D48.5 | complete | 0.3664 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000081 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 27,125 | documentation | 0.2184 | policy-specialty-clinic-payer-001-office_eval | 24 | false | false | 3 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5614 | specialty-clinic-payer-001 | mid-atlantic | office | true | 99,214 | office_eval | not_required | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.6 | baseline | 1 | 2026-09-19 | north-texas | 2026-09-15 | office | dermatologic | 2026-09-26 | 2026-09 | 784,732 | 1,089,905 | 784,732 | null | 0.6633 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-08 | specialty-clinic-payer-001 | deny_missing_documentation | policy-specialty-clinic-payer-001-office_eval | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-11-02 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:procedure | 0.5668 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000082 | null | null | 0.22515 | null | null | null | M54.50 | complete | 0.1837 | low | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000082 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 29,108 | frequency_limit | 0.2186 | policy-specialty-clinic-payer-002-procedure | 31 | false | false | 3 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6776 | specialty-clinic-payer-002 | mid-atlantic | office | true | 20,610 | procedure | approved | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7556 | baseline | 1 | 2026-10-17 | gulf-south | 2026-10-16 | asc | gastrointestinal | 2026-10-27 | 2026-10 | 482,563 | 670,227 | 482,563 | null | 0.86 | 20 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-09 | specialty-clinic-payer-002 | require_authorization | policy-specialty-clinic-payer-002-procedure | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-11-29 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:diagnostic | 0.3854 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000083 | null | null | 0.17075 | null | null | null | E11.9 | complete | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000083 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 23,656 | recoupment_risk | 0.1102 | policy-specialty-clinic-payer-003-diagnostic | 16 | false | false | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4251 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 76,942 | diagnostic | missing | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.4222 | baseline | 1 | 2026-11-19 | north-texas | 2026-11-16 | office | neurological | 2026-11-25 | 2026-11 | 258,358 | 358,831 | 258,358 | null | 0.4973 | 12 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-10 | specialty-clinic-payer-003 | recoup_post_payment_review | policy-specialty-clinic-payer-003-diagnostic | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-12-24 | paid | not_applicable | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:prior_auth_review | 0.4143 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000084 | null | null | 0.1955 | null | null | null | M54.50 | complete | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000084 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 21,225 | recoupment_risk | 0.0881 | policy-specialty-clinic-payer-001-prior_auth_review | 22 | false | true | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5337 | specialty-clinic-payer-001 | mid-atlantic | office | true | 99,214 | prior_auth_review | not_required | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4889 | baseline | 1 | 2026-12-12 | mid-atlantic | 2026-12-05 | hospital_outpatient | musculoskeletal | 2026-12-18 | 2026-12 | 165,132 | 229,350 | 165,132 | null | 0.2432 | 8 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-11 | specialty-clinic-payer-001 | recoup_post_payment_review | policy-specialty-clinic-payer-001-prior_auth_review | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-01-24 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5592 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000085 | null | null | 0.22515 | null | null | null | G56.00 | complete | 0.3841 | medium | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000085 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | false | 2 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,215 | office_eval | expired | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-11 | gulf-south | 2026-01-10 | asc | musculoskeletal | 2026-01-18 | 2026-01 | 392,278 | 544,830 | 392,278 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-02-27 | denied | upheld | 0 | 0.265096 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3993 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000086 | CO | 29 | 0.18575 | N211 | timely-filing | line | K21.9 | missing | 0.5426 | high | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000086 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | false | 2 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | office | true | 64,483 | procedure | missing | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-17 | north-texas | 2026-02-10 | office | musculoskeletal | 2026-02-22 | 2026-02 | 687,340 | 954,639 | 0 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-31 | denied | upheld | 0 | 0.268755 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4875 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000087 | CO | 27 | 0.21925 | N382 | eligibility | line | E11.9 | missing | 0.6053 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000087 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | false | 2 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | office | true | 73,721 | diagnostic | not_required | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-20 | north-texas | 2026-03-13 | asc | neurological | 2026-03-24 | 2026-03 | 419,791 | 583,043 | 0 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-05-04 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5515 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000088 | null | null | 0.22515 | null | null | null | M54.50 | missing | 0.3841 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000088 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | false | 1 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,214 | prior_auth_review | approved | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-19 | gulf-south | 2026-04-13 | office | neurological | 2026-04-27 | 2026-04 | 168,545 | 234,090 | 168,545 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-05-28 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:office_eval | 0.3701 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000089 | null | null | 0.17075 | null | null | null | K57.30 | partial | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000089 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 21,781 | frequency_limit | 0.0602 | policy-specialty-clinic-payer-003-office_eval | 14 | false | false | 3 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.414 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 99,213 | office_eval | missing | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.3778 | baseline | 1 | 2026-05-19 | north-texas | 2026-05-14 | asc | dermatologic | 2026-05-21 | 2026-05 | 709,667 | 985,649 | 709,667 | null | 0.4973 | 20 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-05 | specialty-clinic-payer-003 | downcode_frequency_exceeded | policy-specialty-clinic-payer-003-office_eval | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-07-02 | paid | not_applicable | 0 | 0.31768 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:procedure | 0.4067 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000090 | null | null | 0.1955 | null | null | null | M54.50 | complete | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000090 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 19,100 | frequency_limit | 0.0381 | policy-specialty-clinic-payer-001-procedure | 21 | false | false | 2 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5281 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 11,042 | procedure | expired | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4667 | baseline | 1 | 2026-06-17 | mid-atlantic | 2026-06-14 | office | dermatologic | 2026-06-30 | 2026-06 | 548,680 | 762,055 | 548,680 | null | 0.2432 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-05 | specialty-clinic-payer-001 | downcode_frequency_exceeded | policy-specialty-clinic-payer-001-procedure | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-07-28 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:diagnostic | 0.5745 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000091 | null | null | 0.22515 | null | null | null | G56.00 | partial | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000091 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 26,936 | frequency_limit | 0.2252 | policy-specialty-clinic-payer-002-diagnostic | 32 | false | false | 3 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6831 | specialty-clinic-payer-002 | mid-atlantic | office | true | 93,000 | diagnostic | missing | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7778 | baseline | 1 | 2026-07-18 | gulf-south | 2026-07-15 | hospital_outpatient | neurological | 2026-07-23 | 2026-07 | 863,694 | 1,199,575 | 863,694 | null | 0.718 | 25 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-06 | specialty-clinic-payer-002 | request_attachment | policy-specialty-clinic-payer-002-diagnostic | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-09-02 | paid | not_applicable | 0 | 0.294112 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:prior_auth_review | 0.393 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000092 | null | null | 0.17075 | null | null | null | M54.50 | partial | 0.3284 | medium | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000092 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,550 | authorization | 0.1354 | policy-specialty-clinic-payer-003-prior_auth_review | 17 | false | true | 3 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4307 | specialty-clinic-payer-003 | gulf-south | office | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4444 | baseline | 1 | 2026-08-16 | north-texas | 2026-08-15 | hospital_outpatient | musculoskeletal | 2026-08-27 | 2026-08 | 540,667 | 750,926 | 540,667 | null | 0.1353 | 19 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-07 | specialty-clinic-payer-003 | require_authorization | policy-specialty-clinic-payer-003-prior_auth_review | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-10-02 | paid | not_applicable | 0 | 0.311695 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:office_eval | 0.4813 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000093 | null | null | 0.20425 | null | null | null | D48.5 | complete | 0.1752 | high | specialty-clinic-benefit-standard | intent:specialty-clinic:000093 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 27,125 | documentation | 0.2184 | policy-specialty-clinic-payer-001-office_eval | 24 | false | false | 3 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5614 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 99,214 | office_eval | not_required | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.6 | baseline | 1 | 2026-09-16 | north-texas | 2026-09-15 | asc | endocrine_metabolic | 2026-09-26 | 2026-09 | 838,211 | 1,164,182 | 838,211 | null | 0.6633 | 13 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-08 | specialty-clinic-payer-001 | deny_missing_documentation | policy-specialty-clinic-payer-001-office_eval | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-11-01 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:procedure | 0.5668 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000094 | null | null | 0.22515 | null | null | null | E03.9 | complete | 0.3841 | medium | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000094 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 29,108 | frequency_limit | 0.2186 | policy-specialty-clinic-payer-002-procedure | 31 | false | true | 3 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6776 | specialty-clinic-payer-002 | mid-atlantic | hospital_outpatient | true | 20,610 | procedure | approved | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7556 | baseline | 1 | 2026-10-17 | gulf-south | 2026-10-16 | office | neurological | 2026-10-27 | 2026-10 | 562,036 | 780,606 | 562,036 | null | 0.86 | 20 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-09 | specialty-clinic-payer-002 | require_authorization | policy-specialty-clinic-payer-002-procedure | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
2026-11-28 | denied | upheld | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:diagnostic | 0.3854 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000095 | CO | 29 | 0.17075 | N211 | timely-filing | claim | K57.30 | missing | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000095 | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | 23,656 | recoupment_risk | 0.1102 | policy-specialty-clinic-payer-003-diagnostic | 16 | false | false | 2 | specialty-clinic-member-000005 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4251 | specialty-clinic-payer-003 | gulf-south | ambulatory_surgery | true | 76,942 | diagnostic | approved | specialty-clinic-provider-00014 | Multi-Specialty Clinic | 207Q00000X | 0.4222 | baseline | 1 | 2026-11-17 | north-texas | 2026-11-16 | asc | endocrine_metabolic | 2026-11-25 | 2026-11 | 513,595 | 713,327 | 0 | null | 0.4973 | 12 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00014-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-006 | world-specialty-clinic-2995344627 | specialty-clinic-member-000005 | ops-specialty-clinic-provider-00014-2026-10 | specialty-clinic-payer-003 | recoup_post_payment_review | policy-specialty-clinic-payer-003-diagnostic | specialty-clinic-provider-00014 | north-texas | 0.0602 |
2026-12-20 | paid | not_applicable | 0 | 0.303145 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:mid-atlantic:prior_auth_review | 0.4143 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000096 | null | null | 0.1955 | null | null | null | L30.9 | partial | 0.3664 | medium | specialty-clinic-benefit-standard | intent:specialty-clinic:000096 | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | 21,225 | recoupment_risk | 0.0881 | policy-specialty-clinic-payer-001-prior_auth_review | 22 | false | true | 1 | specialty-clinic-member-000006 | in_network | 0.12 | specialty-clinic | 0 | bcbs_like | 0.5337 | specialty-clinic-payer-001 | mid-atlantic | ambulatory_surgery | true | 99,214 | prior_auth_review | missing | specialty-clinic-provider-00012 | Multi-Specialty Clinic | 207Q00000X | 0.4889 | baseline | 1 | 2026-12-12 | mid-atlantic | 2026-12-05 | office | dermatologic | 2026-12-18 | 2026-12 | 181,818 | 252,525 | 181,818 | null | 0.2432 | 8 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00012-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-001 | world-specialty-clinic-2995344627 | specialty-clinic-member-000006 | ops-specialty-clinic-provider-00012-2026-11 | specialty-clinic-payer-001 | recoup_post_payment_review | policy-specialty-clinic-payer-001-prior_auth_review | specialty-clinic-provider-00012 | mid-atlantic | 0.0381 |
2026-01-21 | paid | not_applicable | 0 | 0.294308 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:office_eval | 0.5592 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000097 | null | null | 0.22515 | null | null | null | K57.30 | missing | 0.3841 | medium | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000097 | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | 25,019 | frequency_limit | 0.1752 | policy-specialty-clinic-payer-002-office_eval | 30 | false | true | 2 | specialty-clinic-member-000001 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.672 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,215 | office_eval | not_required | specialty-clinic-provider-00002 | Multi-Specialty Clinic | 207Q00000X | 0.7333 | baseline | 1 | 2026-01-17 | gulf-south | 2026-01-10 | asc | dermatologic | 2026-01-18 | 2026-01 | 473,301 | 657,362 | 473,301 | null | 0.718 | 22 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00002-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-002 | world-specialty-clinic-2995344627 | specialty-clinic-member-000001 | ops-specialty-clinic-provider-00002-2026-01 | specialty-clinic-payer-002 | recoup_post_payment_review | policy-specialty-clinic-payer-002-office_eval | specialty-clinic-provider-00002 | gulf-south | 0.1752 |
2026-02-25 | paid | not_applicable | 0 | 0.30836 | 0 | 0.74 | specialty-clinic:baseline:medicare_like:north-texas:procedure | 0.3777 | specialty_clinic_procedure | MB | 837P_like | 1 | specialty-clinic-claim-00000098 | null | null | 0.17075 | null | null | null | G43.909 | missing | 0.1571 | low | specialty-clinic-benefit-cob-heavy | intent:specialty-clinic:000098 | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | 17,384 | clean | 0.0854 | policy-specialty-clinic-payer-003-procedure | 15 | false | true | 1 | specialty-clinic-member-000002 | in_network | 0.28 | specialty-clinic | 0 | medicare_like | 0.4196 | specialty-clinic-payer-003 | gulf-south | office | true | 64,483 | procedure | expired | specialty-clinic-provider-00003 | Multi-Specialty Clinic | 207Q00000X | 0.4 | baseline | 1 | 2026-02-12 | north-texas | 2026-02-10 | hospital_outpatient | neurological | 2026-02-22 | 2026-02 | 64,683 | 89,837 | 64,683 | null | 0.1353 | 10 | specialty-clinic-benefit-cob-heavy | contract-specialty-clinic-provider-00003-specialty-clinic-payer-003 | medicare_indexed | specialty-clinic-plan-003 | world-specialty-clinic-2995344627 | specialty-clinic-member-000002 | ops-specialty-clinic-provider-00003-2026-01 | specialty-clinic-payer-003 | delay_pending_review | policy-specialty-clinic-payer-003-procedure | specialty-clinic-provider-00003 | north-texas | 0.0854 |
2026-03-28 | paid | not_applicable | 0 | 0.311695 | 0 | 0.74 | specialty-clinic:baseline:bcbs_like:north-texas:diagnostic | 0.4659 | specialty_clinic_procedure | CI | 837P_like | 1 | specialty-clinic-claim-00000099 | null | null | 0.20425 | null | null | null | G56.00 | missing | 0.1752 | low | specialty-clinic-benefit-standard | intent:specialty-clinic:000099 | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | 24,250 | clean | 0.1684 | policy-specialty-clinic-payer-001-diagnostic | 22 | false | false | 3 | specialty-clinic-member-000003 | in_network | 0.28 | specialty-clinic | 0 | bcbs_like | 0.5503 | specialty-clinic-payer-001 | mid-atlantic | hospital_outpatient | true | 73,721 | diagnostic | approved | specialty-clinic-provider-00006 | Multi-Specialty Clinic | 207Q00000X | 0.5556 | baseline | 1 | 2026-03-18 | north-texas | 2026-03-13 | hospital_outpatient | dermatologic | 2026-03-24 | 2026-03 | 717,294 | 996,241 | 717,294 | null | 0.6633 | 9 | specialty-clinic-benefit-standard | contract-specialty-clinic-provider-00006-specialty-clinic-payer-001 | medicare_indexed | specialty-clinic-plan-004 | world-specialty-clinic-2995344627 | specialty-clinic-member-000003 | ops-specialty-clinic-provider-00006-2026-03 | specialty-clinic-payer-001 | delay_pending_review | policy-specialty-clinic-payer-001-diagnostic | specialty-clinic-provider-00006 | north-texas | 0.1684 |
2026-04-30 | paid | not_applicable | 0 | 0.309028 | 0 | 0.74 | specialty-clinic:baseline:medicaid_like:gulf-south:prior_auth_review | 0.5515 | specialty_clinic_procedure | MC | 837P_like | 1 | specialty-clinic-claim-00000100 | null | null | 0.22515 | null | null | null | K21.9 | partial | 0.1837 | high | specialty-clinic-benefit-tight-auth | intent:specialty-clinic:000100 | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | 26,982 | documentation | 0.1686 | policy-specialty-clinic-payer-002-prior_auth_review | 29 | false | false | 2 | specialty-clinic-member-000004 | in_network | 0.28 | specialty-clinic | 0 | medicaid_like | 0.6664 | specialty-clinic-payer-002 | mid-atlantic | office | true | 99,214 | prior_auth_review | approved | specialty-clinic-provider-00009 | Multi-Specialty Clinic | 207Q00000X | 0.7111 | baseline | 1 | 2026-04-16 | gulf-south | 2026-04-13 | hospital_outpatient | endocrine_metabolic | 2026-04-27 | 2026-04 | 220,883 | 306,782 | 220,883 | null | 0.86 | 18 | specialty-clinic-benefit-tight-auth | contract-specialty-clinic-provider-00009-specialty-clinic-payer-002 | medicare_indexed | specialty-clinic-plan-005 | world-specialty-clinic-2995344627 | specialty-clinic-member-000004 | ops-specialty-clinic-provider-00009-2026-04 | specialty-clinic-payer-002 | deny_missing_documentation | policy-specialty-clinic-payer-002-prior_auth_review | specialty-clinic-provider-00009 | gulf-south | 0.1686 |
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