Fictional data. Invented patients, providers, payers, claims and figures. The rules quoted are public CMS and federal text, reproduced word for word and cited by section. No CPT codebook or CPT Assistant text appears anywhere on this page.

Denials Desk

Northgate Physicians Group
Demo built for UASI by The AI Pipe
Invented records, live agent

The indicator says a modifier is allowed. The note says this one is not.

Eight coding denials on the desk this morning, six pages each, and the rules that govern them: chapter I of the NCCI Policy Manual, a national coverage determination, a federal regulation, an invented payer policy and the desk's own standard. The agent reads the provider record line by line against the denied line, ties every code, modifier and unit to the sentence that carries it or does not, and produces the appeal letter or the charge correction sheet. The tools refuse a requirement sourced to the patient record, an argument with no page behind it, and a deadline that was estimated rather than counted.

Measured here, end to end on one denial: run one and watch. That covers the first pass on one denial, being the record read against the denied line, the disposition and the artefact that follows. It does not code, does not recode, does not submit a claim and does not release an appeal.

What this shows

The problem
A coding denial arrives as one line on a remittance advice, and somebody has to read the provider's note against what was actually billed, decide whether the record carries the code, the modifier and the units, and then either argue it or correct it before the appeal window closes.
The result
The run below is real and is recorded: the edit looked up in a table, the record read element by element, the disposition computed from what the review found, and the artefact drafted, with every figure and every requirement carrying the page it came from.
What is simulated, and what is not covered
The group, the eight denials and the payer policy are invented. The CMS and federal extracts are real public text, quoted verbatim; the procedure table and the edit pairs are demonstration data and say so. There is no scanned chart and no optical character recognition, no connection to a practice management system or a clearinghouse, no clinical criteria set, and nothing is submitted anywhere. The tool layer is real: it refuses a rule sourced to the patient record and an appeal argument with no page behind it.
What a pilot would need from your side
A sample of real denials with the names removed, the remittance and the record for each, your own desk rules in whatever form they exist today, and one certified coder who can say whether an answer is right.
Who built it
Frederic de Lavenne de Choulot, The AI Pipe. Built as a demonstration, not sold as a coding, billing or compliance product.

The desk

The rules

Enter to send, shift and enter for a new line. Live tool use over eight denial files and six rule documents.