CLM-58821
837P intake · provider Riverside Imaging
auto-adjudicated · network rate applied · CSR Silver 94
allowed $612.40 · plan paid $537.40 · member $75.00
member portal + mail
Eva answered from this record, verbatim · call attributable
Read to member on a live voice call · audit #4118. Run the guided claims demo — the voice agent reads this record, and the entry lands on this timeline.
From call to claim to case to audit — one platform.
Run the voice demo as Maria, ask Eva about the MRI claim — then come back to CLM-58821 and find the call on its timeline. No vendor stitching, no swivel-chair. That’s what governed integration means.
Two ways every decision gets questioned.
An appeal is a determination someone disagreed with. A member call is a determination being explained. The same spine carries both — SB-1120 puts a licensed physician behind every medical-necessity denial, and CMS-0057-F has required a specific reason on every denial since January 2026, with the FHIR prior-auth API following on 1 January 2027. The record is what survives either one.