CLM-1001Emily JohnsonPaid PartialSLA Low96% AI
Premera Blue Cross · Commercial · Assigned to Michael Carter · Updated 2026-04-22
Patient Name
Emily Johnson
Patient ID
PT-10042
Claim ID
CLM-1001
Visit ID
25998
Payer
Premera Blue Cross
Payer ID
P00234
Carrier Plan
UNITEDHEQ6
Line of Business
Commercial
Provider
Dr. Leo Yonda
Provider NPI
1234567890
Billing Group
BILL2
Date of Service
2026-04-18
Charge Posted
2026-04-19
Charge Amount
$369.00
Paid Amount
$200.00
Adjusted Amount
$0.00
Insurance Balance
$169.00
Patient Balance
$0.00
Primary Payer
Premera Blue Cross
Secondary Payer
N/A
Tertiary Payer
N/A
Crossover
Yes
Assigned To
Michael Carter
SLA Target
24h
SLA Elapsed
10h
SLA Risk
Low
AI Adjudication Recommendation
Patient Balance
96%
Patient Balance. Based on payer Premera Blue Cross, reason codes, and historical patterns, recommended action with 96% confidence.
Evidence: reason codes PR2, CO45; payer history; matched 835 rule.
Risk flags: Possible duplicate visit
Suggested next action: Patient Balance