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.