CLM-1005Sophia ClarkDuplicate SuspectedSLA Low98% AI
Cigna · Commercial · Assigned to Unassigned · Updated 2026-04-22
Patient Name
Sophia Clark
Patient ID
PT-10046
Claim ID
CLM-1005
Visit ID
26003
Payer
Cigna
Payer ID
P00069
Carrier Plan
AETHMO
Line of Business
Commercial
Provider
Dr. Jordan Reed
Provider NPI
1667788990
Billing Group
BILL3
Date of Service
2026-03-21
Charge Posted
2026-03-22
Charge Amount
$700.00
Paid Amount
$700.00
Adjusted Amount
$12.00
Insurance Balance
$0.00
Patient Balance
$0.00
Primary Payer
Cigna
Secondary Payer
N/A
Tertiary Payer
N/A
Crossover
No
Assigned To
Unassigned
SLA Target
24h
SLA Elapsed
48h
SLA Risk
Low
AI Adjudication Recommendation
Hold
98%
Hold. Based on payer Cigna, reason codes, and historical patterns, recommended action with 98% confidence.
Evidence: reason codes none; payer history; matched 835 rule.
Risk flags: none
Suggested next action: Hold