{
"report": {
"claim_id": "e5b44b0c-c8eb-4568-ba91-88065f8382e7",
"created_at": "2025-11-19T21:46:12",
"report_id": "c119bd8b-cdd2-40ee-84a2-e7e63e0fd98f",
"file_uri": "431368ec-0547-4ac7-b280-82b082a30709",
"chart_report": {
"coding_report": {
"icd_10_codes": [
{
"icd_10_code": "F33.1",
"severity": "Low"
},
{
"icd_10_code": "F90.2",
"severity": "Low"
}
],
"cpt_codes": [
{
"cpt_code": "90791",
"severity": "Low"
},
{
"cpt_code": "99213",
"severity": "Low"
}
]
},
"time_based_requirements_report": {
"total_time_documented": {
"label": "Total Time Documented",
"value": "32 minutes",
"severity": "Low"
},
"start_time": {
"label": "Start Time",
"value": "N/A",
"severity": "Medium"
},
"end_time": {
"label": "End Time",
"value": "N/A",
"severity": "Medium"
},
"time_range_matches_procedure": {
"label": "Time Range Matches Procedure",
"value": "N/A",
"severity": "Medium"
},
"codes_consistent": {
"label": "Codes Consistent",
"value": "N/A",
"severity": "Medium"
},
"report_summary": "The start and end times are not explicitly documented, requiring further review to ensure compliance with time-based requirements.",
"status": "Fail",
"title": "Time-Based Requirements Report"
},
"telehealth_documentation_report": {
"patient_location": {
"label": "Patient Location",
"value": "Unclear",
"severity": "Medium"
},
"provider_location": {
"label": "Provider Location",
"value": "Unclear",
"severity": "Medium"
},
"modality": {
"label": "Modality",
"value": "Video and audio",
"severity": "Low"
},
"patient_consent": {
"label": "Patient Consent",
"value": "Implied consent",
"severity": "Low"
},
"report_summary": "Telehealth visit was conducted via video and audio. Implied consent was provided by participating in this encounter.",
"status": "Fail",
"title": "Telehealth Documentation Report"
},
"authentication_report": {
"provider_signature": {
"label": "Provider Signature",
"value": "No",
"severity": "High"
},
"signature_date": {
"label": "Signature Date",
"value": "06/13/2025",
"severity": "High"
},
"provider_credentials": {
"label": "Provider Credentials",
"value": "NP/MD",
"severity": "Medium"
},
"provider_name": {
"label": "Provider Name",
"value": "Unknown",
"severity": "High"
},
"provider_cosignature": {
"label": "Provider Co-Signature",
"value": "Yes",
"severity": "Low"
},
"report_summary": "The document is missing a provider signature, provider name, and signature date.",
"status": "Fail",
"title": "Authentication Report"
},
"documentation_discrepancy_report": {
"chief_complaint_hpi_discrepancy": {
"label": "Chief Complaint HPI Discrepancy",
"value": "No",
"severity": "Low"
},
"ros_hpi_discrepancy": {
"label": "ROS HPI Discrepancy",
"value": "No",
"severity": "Low"
},
"vitals_exam_discrepancy": {
"label": "Vitals Exam Discrepancy",
"value": "No",
"severity": "Low"
},
"report_summary": "All documentation discrepancy requirements are met.",
"status": "Pass",
"title": "Documentation Discrepancy Report"
},
"diagnosis_procedure_report_alignment": {
"diagnosis_matches_code": {
"label": "Diagnosis Matches Code",
"value": "Yes",
"severity": "Low"
},
"laterality_matches_code": {
"label": "Laterality Matches Code",
"value": "Yes",
"severity": "Low"
},
"acute_chronic_discrepancy": {
"label": "Acute/Chronic Discrepancy",
"value": "No",
"severity": "Low"
},
"report_summary": "All diagnosis-procedure alignment requirements are met.",
"status": "Pass",
"title": "Diagnosis Procedure Report Alignment Report"
},
"modifier_bundling_report": {
"modifier_25_check": {
"label": "Modifier 25 Check",
"value": "Yes",
"severity": "Low"
},
"modifier_59_check": {
"label": "Modifier 59 Check",
"value": "No",
"severity": "Low"
},
"modifier_50_check": {
"label": "Modifier 50 Check",
"value": "N/A",
"severity": "Low"
},
"modifier_26_check": {
"label": "Modifier 26 Check",
"value": "N/A",
"severity": "Low"
},
"multiple_modifier_check": {
"label": "Multiple Modifier Check",
"value": "No",
"severity": "Low"
},
"report_summary": "All modifier bundling requirements are met.",
"status": "Pass",
"title": "Modifier Bundling Report"
},
"ncd_lcd_analysis": {
"diagnoses_match_ncd_lcd": {
"label": "Diagnoses Match NCD/LCD",
"value": "Yes",
"severity": "Low"
},
"frequency_discrepancy": {
"label": "Frequency Discrepancy",
"value": "No",
"severity": "Low"
},
"age_discrepancy": {
"label": "Age Discrepancy",
"value": "No",
"severity": "Low"
},
"place_of_service_discrepancy": {
"label": "Place of Service Discrepancy",
"value": "No",
"severity": "Low"
},
"report_summary": "Diagnoses and procedures are compliant with coverage determinations.",
"status": "Pass",
"title": "NCD/LCD Analysis Report"
},
"suggestions_for_fixing_issues_report": {
"suggestions": [
"Since the provider's signature is missing, ensure the provider signs the document before submission.",
"Since the provider's name is missing, ensure the provider's name is added to the document before submission."
]
},
"custom_rules_report": {}
},
"citations": {},
"issues_for_review": 3,
"checks_passed": 4,
"demographics": {
"patient_name": "John Smith",
"provider_name": "Dr. Jones",
"date_of_service": "06/13/2025",
"patient_birth_date": "Unknown",
"facility_name": "Facility Name"
}
}
}
