CLM-1006Benjamin LewisCrossover PendingSLA Medium89% AI
Medicare · Medicare · Assigned to Michael Carter · Updated 2026-04-22
Patient Name
Benjamin Lewis
Patient ID
PT-10047
Claim ID
CLM-1006
Visit ID
26004
Payer
Medicare
Payer ID
P00109
Carrier Plan
UNITEDHEQ6
Line of Business
Medicare
Provider
Dr. Leo Yonda
Provider NPI
1234567890
Billing Group
BILL5
Date of Service
2026-03-14
Charge Posted
2026-03-15
Charge Amount
$500.00
Paid Amount
$0.00
Adjusted Amount
$15.00
Insurance Balance
$495.00
Patient Balance
$5.00
Primary Payer
Medicare
Secondary Payer
Aetna
Tertiary Payer
N/A
Crossover
Yes
Assigned To
Michael Carter
SLA Target
24h
SLA Elapsed
48h
SLA Risk
Medium
AI Adjudication Recommendation
Monitor Crossover
89%
Monitor Crossover. Based on payer Medicare, reason codes, and historical patterns, recommended action with 89% confidence.
Evidence: reason codes none; payer history; matched 835 rule.
Risk flags: none
Suggested next action: Monitor Crossover