DenialPath

Scrub a medical claim against the NCCI procedure-to-procedure and medically unlikely edits in force on its date of service, and explain a CARC/RARC denial from a remittance. No model: every answer is a deterministic projection of a cited CMS or X12 dataset, so identical input always returns an identical verdict. A finding or lookup status of no_data means the code or pair was never checked against our dataset - it is NOT a pass, and CMS may still deny a claim on an edit outside our loaded subset. A confidence of "verify" means the value could not be confirmed against the official source and must be treated as unverified, not as fact. Every versioned edit carries the CMS quarter it applies to. Procedure codes are referenced numerically only: CPT long descriptors are AMA-copyrighted and are never reproduced here. This is billing and administrative guidance citing CMS or X12 sources - it is not medical advice, not a coverage determination, and not a guarantee of payment. draft_appeal is t