# Claims-Denial Case — Mission 3 Evidence

Reveal this fictional source only after recording the inherited-brief conflict.
It supplies a measured NorthLake baseline and an imminent economic decision. It
does not establish Summit behavior, correction quality, or customer acceptance.

## S6 — July operations extract

Population query: NorthLake inpatient medical-necessity denials received 1–31 Jul.

- 186 denials returned; 151 had a reviewed correction.
- Median time from denial receipt to reviewed correction: 42 minutes.
- Median specialist active time recorded by the workbench: 24 minutes.
- 21 corrections involved a modifier; 7 had a manually restored modifier 25.
- 18 records lacked a linked encounter note at review time.
- No Summit cohort was extracted.
- “Correct correction” exists as a free-text reviewer field. No named label owner,
  adjudication procedure, or inter-reviewer agreement is recorded.

## Decision event and economics

The practice leader must recommend fund, reshape, defer, or stop for the next
implementation phase at a steering review on 20 Aug.

- Economic exposure: CAD 240,000 remaining fixed-fee delivery budget.
- Sponsor estimate basis: 1,200 monthly cases and fifteen minutes per claim today;
  no measured time saving is established by that statement.
- Evidence-supported NorthLake basis: 186 July cases; observed and measured time
  differs from the sponsor estimate.
- Interim continuation floor proposed by delivery: at least 15 percent reduction
  in median receipt-to-reviewed-correction time, at least 70 percent adoption in the
  eligible cohort, no unauthorized submissions, no increase in independently
  adjudicated correction error, and full operating cost below CAD 18 per case.
- The SOW's 30 percent average-handling-time improvement remains the sold acceptance
  target. The proposed 15 percent median cycle-time floor is an interim four-week
  continuation condition, not an amendment or proxy for that commercial target.
- Independent metric verifier and correction-label authority remain unassigned.

Complete Mission 3 before opening the
[Missions 4–5 design stop](https://www.lumyn.cc/resources/claims-denial-stage-4-5/).