Synthetic data prototype — no PHI. Numbers, names, and IDs are fabricated for design review only.
Billing & Revenue
Packet readiness, claim status, and revenue realization
Track TCM (99495/99496) and PCM (99426/99427) billing pipeline from encounter through payment, with exception flags blocking revenue.
Filters
Billing Ready Packets
44
TCM complete + PCM billable
Claims Submitted
36
5.5d svc → submit
Claims Paid
16
15.7d submit → pay
Claims Denied
8
3 reasons
Expected Allowed
$4,840
of $6,974 billed
Paid Amount
$2,563
Revenue Realization
53%
paid ÷ allowed
Blocked Revenue
$3,015
denied + pending
Claim Status Breakdown
Distribution across 40 billing records
Revenue: Expected vs Paid by Month
Allowed amount on claims vs amounts paid by payers
TCM vs PCM Revenue Split
Paid revenue by program
Denial Reasons
Count and blocked dollars by reason
Billing Cycle Timeline
Cohort progression from encounter → note completion → note sent → claim submit → payment
Stage 1
Encounter
100%
Stage 2
Note Completed
94%
Stage 3
Note Sent to USC
83%
Stage 4
Claim Submitted (5.5d avg)
90%
Stage 5
Payment (15.7d avg)
40%
Billing Readiness Exceptions
· 44 total flags blocking billing readiness7
TCM billing-ready: false
2
Note missing
5
Note not sent to USC
29
PCM monthly minutes not met
1
PCM monthly note incomplete
0
Denied claims missing reason
TCM vs PCM Paid Revenue Trend
Billing Records (40)
Click a row to drill into the patient timeline
| Billing ID | Patient / Episode | Service / CPT | Source Ref | DOS | Submit Date | Billing Entity | Payer | Allowed / Billed / Paid | Claim | Payment | Denial Reason |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BILL-0001 | Maria AlvarezPT-000001 · EPI-2026-0001 | TCM CPT 99495 | TCM-0001 | Feb 04, 2026 | Feb 07, 2026 | USC Urology Clinical Services | Medicare FFS | $168 / $209 / $168 | Paid | Paid | — |
| BILL-0002 | Thomas BennettPT-000002 · EPI-2026-0002 | TCM CPT 99496 | TCM-0002 | Mar 17, 2026 | Mar 19, 2026 | USC Urology Clinical Services | United Healthcare | $220 / $281 / $0 | Submitted | Pending | — |
| BILL-0003 | Linda ChenPT-000003 · EPI-2026-0003 | TCM CPT 99495 | TCM-0003 | Feb 17, 2026 | Feb 20, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $164 / $209 / $164 | Paid | Paid | — |
| BILL-0004 | Robert DavisPT-000004 · EPI-2026-0004 | TCM CPT 99495 | TCM-0004 | Feb 25, 2026 | Mar 03, 2026 | USC Urology Clinical Services | Anthem Blue Cross | $174 / $209 / $174 | Paid | Paid | — |
| BILL-0005 | George FloresPT-000006 · EPI-2026-0006 | TCM CPT 99495 | TCM-0005 | Feb 07, 2026 | Feb 14, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $0 / $209 / $0 | Denied | Denied | Eligibility issue |
| BILL-0006 | Ellen GreenePT-000007 · EPI-2026-0007 | TCM CPT 99495 | TCM-0006 | Feb 15, 2026 | — | USC Urology Clinical Services | Anthem Blue Cross | $180 / $209 / $0 | Draft | Pending | — |
| BILL-0007 | Samuel HernandezPT-000008 · EPI-2026-0008 | TCM CPT 99495 | TCM-0007 | Mar 04, 2026 | Mar 09, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $184 / $209 / $184 | Paid | Paid | — |
| BILL-0008 | Barbara LawsonPT-000011 · EPI-2026-0011 | TCM CPT 99496 | TCM-0008 | Mar 01, 2026 | Mar 08, 2026 | USC Urology Clinical Services | Anthem Blue Cross | $251 / $281 / $0 | Submitted | Pending | — |
| BILL-0009 | Susan NguyenPT-000013 · EPI-2026-0013 | TCM CPT 99496 | TCM-0009 | Mar 20, 2026 | Mar 26, 2026 | USC Urology Clinical Services | Medicare FFS | $0 / $281 / $0 | Denied | Denied | Eligibility issue |
| BILL-0010 | Donald OwensPT-000014 · EPI-2026-0014 | TCM CPT 99495 | TCM-0010 | Mar 01, 2026 | Mar 08, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $179 / $209 / $0 | Submitted | Pending | — |
| BILL-0011 | Karen ParkPT-000015 · EPI-2026-0015 | TCM CPT 99495 | TCM-0011 | Mar 24, 2026 | Mar 26, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $185 / $209 / $0 | Submitted | Pending | — |
| BILL-0012 | Edward QuinnPT-000016 · EPI-2026-0016 | TCM CPT 99495 | TCM-0012 | Feb 25, 2026 | Feb 27, 2026 | USC Urology Clinical Services | Medicare FFS | $186 / $209 / $186 | Paid | Paid | — |
| BILL-0013 | Helen ReyesPT-000017 · EPI-2026-0017 | TCM CPT 99495 | TCM-0013 | Feb 20, 2026 | Feb 24, 2026 | USC Urology Clinical Services | United Healthcare | $168 / $209 / $168 | Paid | Paid | — |
| BILL-0014 | Kevin UnderwoodPT-000020 · EPI-2026-0020 | TCM CPT 99496 | TCM-0014 | Mar 15, 2026 | Mar 19, 2026 | USC Urology Clinical Services | Medicare FFS | $238 / $281 / $238 | Paid | Paid | — |
| BILL-0015 | Sandra VargasPT-000021 · EPI-2026-0021 | TCM CPT 99495 | TCM-0015 | Jan 17, 2026 | Jan 22, 2026 | USC Urology Clinical Services | Anthem Blue Cross | $0 / $209 / $0 | Denied | Denied | Timely filing |
| BILL-0016 | Donna XuPT-000023 · EPI-2026-0023 | TCM CPT 99496 | TCM-0016 | Feb 08, 2026 | Feb 14, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $221 / $281 / $221 | Paid | Paid | — |
| BILL-0017 | Emily ZhangPT-000025 · EPI-2026-0025 | TCM CPT 99495 | TCM-0017 | Mar 08, 2026 | Mar 14, 2026 | USC Urology Clinical Services | Medicare FFS | $0 / $209 / $0 | Denied | Denied | Eligibility issue |
| BILL-0018 | Frank AdlerPT-000026 · EPI-2026-0026 | TCM CPT 99495 | TCM-0018 | Jan 28, 2026 | Jan 31, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $186 / $209 / $186 | Paid | Paid | — |
| BILL-0019 | Howard CarterPT-000028 · EPI-2026-0028 | TCM CPT 99495 | TCM-0019 | Feb 16, 2026 | Feb 22, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $181 / $209 / $181 | Paid | Paid | — |
| BILL-0020 | Janet FosterPT-000031 · EPI-2026-0031 | TCM CPT 99495 | TCM-0021 | Mar 18, 2026 | — | USC Urology Clinical Services | Aetna | $183 / $209 / $0 | Draft | Pending | — |
| BILL-0021 | Mark IversonPT-000034 · EPI-2026-0034 | TCM CPT 99496 | TCM-0022 | Feb 09, 2026 | Feb 15, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $224 / $281 / $0 | Submitted | Pending | — |
| BILL-0022 | Rachel NewmanPT-000039 · EPI-2026-0039 | TCM CPT 99496 | TCM-0023 | Feb 22, 2026 | Feb 26, 2026 | USC Urology Clinical Services | Aetna | $247 / $281 / $247 | Paid | Paid | — |
| BILL-0023 | Steven OrtegaPT-000040 · EPI-2026-0040 | TCM CPT 99495 | TCM-0024 | Mar 13, 2026 | Mar 19, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $176 / $209 / $0 | Pending | Pending | — |
| BILL-0024 | Teresa PruittPT-000041 · EPI-2026-0041 | TCM CPT 99495 | TCM-0025 | Feb 06, 2026 | Feb 11, 2026 | USC Urology Clinical Services | Medicare FFS | $186 / $209 / $0 | Pending | Pending | — |
| BILL-0025 | Vincent RomeroPT-000042 · EPI-2026-0042 | TCM CPT 99495 | TCM-0026 | Apr 02, 2026 | Apr 09, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $169 / $209 / $169 | Paid | Paid | — |
| BILL-0026 | George FloresPT-000006 · EPI-2026-0006 | PCM CPT 99426 | PMR-0004 | Apr 15, 2026 | Apr 18, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $72 / $83 / $0 | Submitted | Pending | — |
| BILL-0027 | Susan NguyenPT-000013 · EPI-2026-0013 | PCM CPT 99426 | PMR-0007 | Apr 15, 2026 | Apr 25, 2026 | USC Urology Clinical Services | Medicare FFS | $70 / $83 / $0 | Submitted | Pending | — |
| BILL-0028 | Helen ReyesPT-000017 · EPI-2026-0017 | PCM CPT 99426 | PMR-0010 | Apr 15, 2026 | Apr 25, 2026 | USC Urology Clinical Services | United Healthcare | $67 / $83 / $67 | Paid | Paid | — |
| BILL-0029 | Janet FosterPT-000031 · EPI-2026-0031 | PCM CPT 99426 | PMR-0016 | Apr 15, 2026 | Apr 22, 2026 | USC Urology Clinical Services | Aetna | $67 / $83 / $67 | Paid | Paid | — |
| BILL-0030 | Thomas BennettPT-000002 · EPI-2026-0002 | PCM CPT 99426 | PMR-0020 | Apr 15, 2026 | Apr 23, 2026 | USC Urology Clinical Services | United Healthcare | $0 / $83 / $0 | Denied | Denied | Eligibility issue |
| BILL-0031 | Ellen GreenePT-000007 · EPI-2026-0007 | PCM CPT 99426 | PMR-0024 | Apr 15, 2026 | — | USC Urology Clinical Services | Anthem Blue Cross | $72 / $83 / $0 | Draft | Pending | — |
| BILL-0032 | Donald OwensPT-000014 · EPI-2026-0014 | PCM CPT 99426 | PMR-0026 | Mar 15, 2026 | — | USC Urology Clinical Services | Humana Medicare Advantage | $67 / $83 / $0 | Draft | Pending | — |
| BILL-0033 | Karen ParkPT-000015 · EPI-2026-0015 | PCM CPT 99426 | PMR-0027 | Apr 15, 2026 | Apr 22, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $0 / $83 / $0 | Denied | Denied | Time threshold not documented |
| BILL-0034 | Sandra VargasPT-000021 · EPI-2026-0021 | PCM CPT 99426 | PMR-0028 | Mar 15, 2026 | Mar 21, 2026 | USC Urology Clinical Services | Anthem Blue Cross | $68 / $83 / $0 | Submitted | Pending | — |
| BILL-0035 | George FloresPT-000006 · EPI-2026-0006 | PCM CPT 99426 | PMR-0004 | Apr 15, 2026 | Apr 21, 2026 | USC Urology Clinical Services | Humana Medicare Advantage | $71 / $83 / $0 | Pending | Pending | — |
| BILL-0036 | Susan NguyenPT-000013 · EPI-2026-0013 | PCM CPT 99426 | PMR-0007 | Apr 15, 2026 | Apr 25, 2026 | USC Urology Clinical Services | Medicare FFS | $69 / $83 / $69 | Paid | Paid | — |
| BILL-0037 | Helen ReyesPT-000017 · EPI-2026-0017 | PCM CPT 99426 | PMR-0010 | Apr 15, 2026 | Apr 19, 2026 | USC Urology Clinical Services | United Healthcare | $73 / $83 / $0 | Pending | Pending | — |
| BILL-0038 | Janet FosterPT-000031 · EPI-2026-0031 | PCM CPT 99426 | PMR-0016 | Apr 15, 2026 | Apr 18, 2026 | USC Urology Clinical Services | Aetna | $0 / $83 / $0 | Denied | Denied | Eligibility issue |
| BILL-0039 | Thomas BennettPT-000002 · EPI-2026-0002 | PCM CPT 99426 | PMR-0020 | Apr 15, 2026 | Apr 19, 2026 | USC Urology Clinical Services | United Healthcare | $74 / $83 / $74 | Paid | Paid | — |
| BILL-0040 | Ellen GreenePT-000007 · EPI-2026-0007 | PCM CPT 99426 | PMR-0024 | Apr 15, 2026 | Apr 22, 2026 | USC Urology Clinical Services | Anthem Blue Cross | $0 / $83 / $0 | Denied | Denied | Eligibility issue |