Findings

5 findings, $4,390.00 in appealable and recoverable exposure across your claims

Includes plan-side dollars on denials and duplicates. The dollars that come back to you directly are smaller, and each card's evidence shows whose money moves.

run run-1783043067872-3206b0c4

Token meter

Context tokens and cost for this run, measured on the flattened context Clawback actually reads.

replayed run

92.1%

smaller context after flattening

3924

input tokens

10243

output tokens

$0.17

cost this run

Eval scores are measured on the flattened context. Latest anomaly F1 is 100.0%. A raw-context A/B baseline has not been run yet.

see Evals

Cost is computed at the published claude-sonnet-5 rates of $3.00 per million input tokens and $15.00 per million output tokens. Token counts are estimated at about 4 characters per token. A live API run measures them exactly.

View as table

raw FHIR JSON tokens	24610
flattened tokens	1936
reduction	92.1%
input tokens	3924
output tokens	10243
cost this run	$0.17

This demo runs in replay mode by default, serving a real captured run with no API calls and no cost. To run it live, bring your own Anthropic key. It stays in your browser and this one request, and is never stored, logged, or shown back.

denialhigh confidence

Echocardiogram, complete (CPT 93306) billed $2,340 was denied in full with reason code CO-50 (not deemed a medical necessity by the payer). Paid amount is $0 and the full billed amount was shifted to noncovered. Medical-necessity denials are frequently appealable when supporting clinical documentation is submitted.

$2,340.00

at issue

Ask St. Aurelia Medical Center for the ordering physician's clinical notes/diagnosis supporting the echocardiogram, then have a human reviewer decide whether to file a medical-necessity appeal with that documentation attached.

Clawback explains and drafts. Decisions about your claim stay with you and your plan.

denialhigh confidence

MRI lumbar spine (CPT 72148) billed $1,480 was denied in full with reason code CO-197 (precertification/authorization/notification absent). Paid amount is $0 and the entire billed amount was shifted to noncovered. This is a procedural denial, not a medical-necessity determination, and those are often reversible if a prior authorization was in fact obtained or can be retroactively documented.

$1,480.00

at issue

Have the member (or Midtown Imaging Center) check for an existing prior-authorization number for this MRI. If one exists, ask the plan to reprocess the claim with that reference attached. If none exists, ask the provider's billing office to confirm whether authorization was requested before the scan. This is worth a human reviewer's look before any appeal is filed.

Clawback explains and drafts. Decisions about your claim stay with you and your plan.

duplicate chargehigh confidence

Two claims from Lakeview Family Medicine on the same service date (2025-11-06), same code (CPT 99214, office visit), same billed amount ($285), were both paid separately ($255 paid on each). One of these two line items is a likely double-billed office visit for a single encounter, worth roughly $285 in redundant charges.

$285.00

at issue

Next step. Ask Lakeview Family Medicine to confirm whether two separate, medically distinct office visits actually occurred on 2025-11-06. If not, have a human reviewer request the plan void one of the two paid claims and refund the associated member cost share.

out-of-pocket errormedium confidence

Summing the deductible column across 2026 claims in date order reaches the plan's $3,000 family deductible on 2026-04-11 (eob-2026-burn-4): $900 + $300 + $850 + $700 + $250 = $3,000. The next claim with a deductible applied, anomaly-oop-1 on 2026-06-09 (Riverbend Orthopedics, joint injection), still had a $250 deductible charged even though the family deductible was already fully met seven weeks earlier.

$250.00

at issue

Next step. Have a human reviewer pull the plan's deductible accumulator/EOB summary for 2026 to confirm the family deductible was met by 2026-04-11, then ask the plan to reprocess anomaly-oop-1 without the $250 deductible and refund that amount to the member.

billing errorhigh confidence

Corner Pharmacy #204 charged a $45 copay for Lisinopril 10mg, 30 tablets, marked generic. The plan's generic prescription copay tier is $10. The charged copay is $35 higher than the plan design allows for a generic drug.

$35.00

at issue

Next step. Have the member confirm at the pharmacy counter that this fill was the generic (not a brand substitution billed as generic). If confirmed generic, ask the plan or pharmacy to reprocess at the $10 generic copay and refund the $35 difference.