- Shipped
- August 25, 2026 at 9:10 PM UTC
- Author
- Kamo
- Commit
- d3a2e93
Every list here exists because its failure mode is a MISSING row rather than a wrong one, which is why none of them show up in an ordinary report. A claim a clearinghouse rejected never reached the payer: it is in no denial report because nobody denied it, in no payment report because nobody paid it, and its status changed once, quietly, weeks ago. Practices lose more money to that silence than to denials they fought and lost. Timely filing is the only absolute deadline in the cycle — past it the money is gone with no appeal — and it counts rejected claims as unfiled, because a claim a clearinghouse stopped has not been filed however many times it was sent. A procedure performed and never charged raises nothing at all, since the charge was simply never created. Money that arrived and cannot be attributed reconciles perfectly the moment somebody adjusts it away, which is exactly how a ledger stops being trustworthy. Denials are grouped by CARC code and CPT rather than listed, because one procedure denied twenty times for one reason is a fixable pattern and the same twenty listed individually are twenty chores. mayBillInsurance is the exception: not a worklist, a refusal. A §164.522(a)(1)(vi) restriction is MANDATORY — when a patient pays out of pocket in full, a covered entity must agree not to tell their health plan — and billing anyway is a violation that cannot be cured, because the disclosure has already happened and there is no recalling a claim a payer adjudicated. It answers with a REASON rather than a boolean, because "this cannot be billed" with no explanation invites somebody to work around it. A restriction that limits who may be TOLD about a visit does not block billing it; conflating the two would refuse claims the practice is entitled to file. Outstanding excludes the patient's share throughout: chasing a payer for a copay is how a practice annoys a payer and never bills the patient. And an unadjudicated claim owes nothing YET rather than its full charge — reporting the charge would overstate every practice's receivables. 1235 tests green.