CLM-1004James WilsonPaid PartialSLA Low94% AI
United Healthcare · Commercial · Assigned to Laura Bennett · Updated 2026-04-22
Patient Name
James Wilson
Patient ID
PT-10045
Claim ID
CLM-1004
Visit ID
26002
Payer
United Healthcare
Payer ID
P00224
Carrier Plan
BCBSPPO
Line of Business
Commercial
Provider
Dr. Sasha Park
Provider NPI
1556677889
Billing Group
BILL2
Date of Service
2026-03-28
Charge Posted
2026-03-29
Charge Amount
$450.00
Paid Amount
$300.00
Adjusted Amount
$9.00
Insurance Balance
$150.00
Patient Balance
$0.00
Primary Payer
United Healthcare
Secondary Payer
Medicaid NJ
Tertiary Payer
N/A
Crossover
No
Assigned To
Laura Bennett
SLA Target
24h
SLA Elapsed
48h
SLA Risk
Low
AI Adjudication Recommendation
Bill Next
94%
Bill Next. Based on payer United Healthcare, reason codes, and historical patterns, recommended action with 94% confidence.
Evidence: reason codes PR2; payer history; matched 835 rule.
Risk flags: none
Suggested next action: Bill Next