Where Do Downcoding and Returned Claims Actually Happen? — Taking Apart Receipt Checking Logic Using ORCA's Source Code and Public Documents (archived 2026-08-30)

Abstract

Where do downcoding and returned claims actually happen? From ORCA's data check function and its check masters, through the rece-den data check, to the computer checks, cross-matching review and longitudinal review performed by the claims review and payment bodies — this article explains the multi-stage structure of receipt checking using published source code and public documents. Archived version of https://comcomponent.com/en/blog/receipt-check-assessment-logic/, as published on 2026-08-30. The live article is maintained and may change after this date. First published 2026-07-18.