CLM-1002William AndersonNo ResponseSLA Medium91% AI
Aetna · Commercial · Assigned to Sarah Mitchell · Updated 2026-04-22
Patient Name
William Anderson
Patient ID
PT-10043
Claim ID
CLM-1002
Visit ID
25999
Payer
Aetna
Payer ID
P00066
Carrier Plan
ASDPLANS12
Line of Business
Commercial
Provider
Dr. Mira Chen
Provider NPI
1098765432
Billing Group
BILL3
Date of Service
2026-03-16
Charge Posted
2026-03-17
Charge Amount
$1,240.00
Paid Amount
$0.00
Adjusted Amount
$3.00
Insurance Balance
$1,229.00
Patient Balance
$11.00
Primary Payer
Aetna
Secondary Payer
N/A
Tertiary Payer
N/A
Crossover
No
Assigned To
Sarah Mitchell
SLA Target
24h
SLA Elapsed
48h
SLA Risk
Medium
AI Adjudication Recommendation
Start Payer Status Agent
91%
Start Payer Status Agent. Based on payer Aetna, reason codes, and historical patterns, recommended action with 91% confidence.
Evidence: reason codes none; payer history; matched 835 rule.
Risk flags: none
Suggested next action: Start Payer Status Agent