A hospital that does not exist

Hammer Remit

Checks that read a hospital's records and say where each claim's money stopped, what it should have paid against the contract, what should have been caught before the claim went out, and what the record holds when you decide to appeal.

The sweep

What the world was asked, and what it said

The agent opens the book, sweeps it and reads the findings back. Each call it makes is a row below, with the intent it named, the arguments it passed and the record ids the world's answer carried. The narration is the model's; every figure in it was served by a call on the left or it is named as unserved.

Calls

Narration

The findings, largest first

…

Claim	Stage	Kind	Outstanding	Class	Date of service	Ask

The class is the claim's from the answer key; rest on it to read what settles that class. "Ask" puts the question about that claim into the box at the bottom of the page.

HELD

What the record holds

Every figure here is the world's ledger over this book, read off the sweep's answer as served. The world computes these from the estimator's findings and the contract terms and declares nothing.

gross at risk: …
past the window: …
actionable before declared deductions: …

By age, from the date of service

Age	Findings	Outstanding

By stage and by kind

Stage	Findings	Outstanding

By class of truth

Cases and flagged cases per class, from the answer key the book ships. The four sentences are the leaderboard's.

Class	Cases	Flagged	What settles it	The right answer
records	…	…	a claim, remittance, settlement, deposit, ledger posting, authorisation, eligibility response, NCCI table, contract term or dated policy version	the finding, at the stage the money stopped, with the line and the record; every labelled missing dollar is in this class, so its recall is the headline
chart	…	…	the clinical note, deterministically: minutes against units billed, a diagnosis present or absent, a signature date against a submission date	silence. No money moved, and v1's scorer asks a payment question; a payment tool that reports anything here is wrong. Grading the chart answer is a later release
judgement	…	…	nothing in the book. Whether the service was indicated is a clinician's opinion, and credentialed reviewers reading the same chart disagree often enough that the disagreement is the signal	silence, by design. Planted as a control group: billed, paid, documented, every record agreeing with every other. The score here is how often a tool flagged what no record could settle
clean	…	…	nothing was planted and nothing in the records disagrees	silence

…

DECLARED

The reader's arithmetic, not the world's

The world refuses to state a recovery amount or an appeal probability, and that refusal stands. What follows is arithmetic this page does in the browser over the ledger above and inputs you can see and move. Nothing here is served, and nothing here goes back to the world.

Denials not worth an appeal

an appeal does not overturn these. The list is ours, printed so a reader can disagree with it. It is applied to the live line_adjudicated_zero findings whose denial codes meet it, read off the ledger's grain by code set, and to nothing else.

CARC 18: exact duplicate claim or service
CARC 97: included in the payment for another service
CARC 204: not covered under the patient's benefit plan
CARC 197: authorisation absent

The rates

appeal success rate declared 0.40 how often an appeal of a denied line wins; applied to line_adjudicated_zero

cost to work one finding declared $25 a status call, an appeal letter, a posting correction: an operator's number, never ours

resubmission pays rate derived 0.81 one minus the denial rate the book is calibrated to; applied to line_not_adjudicated

documented payment rate declared 1.0 a payment the remittance documents and the ledger has not matched is money that exists; applied to every other kind

Gross to net

Run a sweep and the ledger's live findings by kind fill this table.

Kind	Surviving findings	Live (held)	Not appealable (declared)	Actionable	Rate (declared)	Expected (arithmetic)

not appealable: …
actionable: …
expected recovery: …
cost to work: …
net: …

the reader's arithmetic, not the world's: the rows past their window and the rows meeting the declared list are already out; the expected recovery is each kind's actionable amount times the rate above, rounded once per kind; the cost is one surviving finding worked once; the net is the difference. The actionable figure here is the held one above less what the declared list takes out.