CLM-2025-001848
Horizon Behavioral Health Partners · Aetna · 837P
⌘K
AI Correction Recommendation
Verify mental health benefit coverage. Aetna requires pre-auth for 90837 > 8 sessions. Check auth on file.
AI Confidence: High
CLM-2025-001848
RejectedHorizon Behavioral Health Partners · Aetna
$1,240.00
0Provider
Dr. Sandra Okafor
Patient Ref
PT-29034
Service Date
2025-01-11
Claim Type
837P
Billing Summary
Diagnosis Codes
F32.1F41.1
Procedure Codes
9083790791
Denial / Rejection Analysis
CO-4: Service/Procedure not covered by this payer
Source: Payer adjudication response via Claim.MD 999 acknowledgement
Route: MASE → Claim.MD adapter → Aetna EDI
Claim Timeline
Claim created and imported10:01 AM
Received via batch upload
MASE Rules Engine — Scrub initiated10:01 AM
8 rules evaluated
MASE AI Scrub completed10:02 AM
Passed all validation checks
Routed to Claim.MD adapter10:03 AM
claimmd-claims-adapter v2.1
Submitted to payer via Claim.MD10:04 AM
ISA batch 00421 · GS group 004
999 Acknowledgement received10:05 AM
AK2 accepted — Functional Group OK
MASE AI Scrub
Risk Score87 / 100
Scrub ResultFlagged
Rules Evaluated8 / 8
AI Modelmase-scrub-v3.1
Claim.MD Transaction Trace
Routing StatusRejected
Ack ResultRejected - CO-4
Adapterclaimmd-claims-adapter
ISA Batch00421
Correction Checklist
Recommended Next Action
Apply AI-suggested correction, update claim data, and resubmit via MASE correction workflow.