Behavioral Health100K-500K+
ABA Claims
Authorization units, reauthorization drift, caregiver context, and clean-claim agent pressure.
Unit exhaustion mid-authorization
Reauthorization lag
Synthetic Claims Catalog
20 packs across 5 care settings. Synthetic claims with the denial behavior real systems have: CARC/RARC patterns, workflow replays, and scorecards. Buy by pack, delivered by signed link. Zero PHI.
Behavioral Health
3 packsBehavioral Health100K-500K+
Mental Health Claims
Session limits, parity signals, telehealth modality rules, and documentation denials.
Session limit exhaustion
Medical necessity review
Behavioral Health100K-500K+
SUD Claims
ASAM level mismatch, MAT billing, UDS clustering, and concurrent-review friction.
Level-of-care mismatch
Concurrent review gap
Facility
1 packFacility100K-500K+
SNF Medicare Advantage / Nursing Homes
MA payment variance, PDPM logic, authorization friction, and facility AR pressure.
Short-stay medical necessity dispute
PDPM case-mix challenge
Home Health
2 packsHome Health100K-500K+
Home Health Claims
PDGM episodes, face-to-face documentation, NOA timing, and certification risk.
Late NOA penalty pressure
Face-to-face documentation gap
Home Health100K-500K+
Home Infusion / Hospice Claims
Infusion episodes, hospice certification, supplies, care plans, and home-based AR.
Plan-of-care documentation miss
Hospice certification timing
Outpatient
12 packsOutpatient100K-500K+
PT/OT/Rehab Claims
Visit caps, KX threshold pressure, timed-unit logic, and functional-documentation checks.
Visit cap exhaustion
KX threshold pressure
Outpatient100K-500K+
Dialysis Claims
ESRD PPS, MA variance, TDAPA/TPNIES pressure, adequacy, and QIP friction.
Bundled item dispute
Add-on payment denial
Outpatient100K-500K+
Imaging / Radiology Claims
RBM prior authorization, AUC signals, contrast logic, modality routing, and bundling.
RBM authorization denial
AUC documentation miss
Outpatient100K-500K+
DME Claims
Medical necessity, rental cycles, replacement windows, documentation, and delivery proof.
CMN or documentation miss
Rental cycle conflict
Outpatient100K-500K+
Lab / Pathology Claims
Medical-necessity edits, panel bundling, pathology documentation, and LCD-like pressure.
Medical necessity diagnosis mismatch
Panel bundling denial
Outpatient100K-500K+
Oncology Claims
Infusion cadence, specialty-drug authorization, cycle timing, and oncology AR.
Specialty-drug authorization lag
Cycle timing mismatch
Outpatient100K-500K+
Cardiology Claims
Diagnostics, procedures, longitudinal monitoring, and cardiac authorization friction.
Procedure authorization denial
Device documentation gap
Outpatient100K-500K+
Ophthalmology Claims
Diagnostics, injection cadence, surgery referrals, and vision-medical benefit edges.
Injection cadence mismatch
Diagnostic documentation gap
Outpatient100K-500K+
Orthopedics / MSK Claims
MSK imaging, procedure authorization, referral leakage, and post-acute therapy routing.
Procedure medical necessity review
Imaging-before-therapy policy pressure
Outpatient100K-500K+
Pain Management Claims
Injection authorization, documentation specificity, and medical-necessity pressure.
Injection frequency denial
Procedure authorization miss
Outpatient100K-500K+
Physician Practice / General Outpatient
E/M, referrals, diagnostics, coding risk, and broad outpatient benchmark behavior.
E/M level downcode
Modifier documentation gap
Outpatient100K-500K+
Telehealth Claims
Modifier rules, site-of-service policy, documentation, and payer-policy drift.
Modifier compliance denial
Place-of-service mismatch
Dental
2 packsDental100K-500K+
Dental Claims
PPO underpayment, downcoding, bundling, frequency limits, and tooth-level context.
Frequency limit denial
CDT downcoding
Dental100K-500K+
Dental Subspecialties Claims
Oral surgery, orthodontics, periodontics, and medical cross-billing behavior.
Orthodontic lifetime benefit pressure
Oral surgery medical cross-billing denial
Need all 20 packs?
Enterprise licensing covers all 20 packs, custom payer archetypes and scenarios, governed replay artifacts, and a dedicated delivery workflow. Synthetic-only.
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