Claim Ledger — event-sourced denial management for behavioral health

A working revenue-cycle workbench for an outpatient behavioral-health group. Every claim is an append-only event log — ClaimDrafted → ClaimScrubbed → ClaimSubmitted (837P) → ClaimAcknowledged (277CA) → RemittanceReceived (835) — and claim state is a left fold over that log, so the audit trail is free and any claim can be replayed to a prior state. Denials are triaged by expected recoverable dollars rather than raw balance, then split into a deterministic lane a machine can clear and a lane that genuinely needs a human.

Denial work queue

Denial mix by reason code

Teal is the modeled recoverable portion; the dark remainder is what the playbook expects to lose. Sorting the book this way is what surfaces that a high-volume code like CO-45 is pure contractual noise while a mid-volume CO-197 is where the recoverable money actually sits.

Denial work queue

Denial mix by reason code

Claim detail