CLM-1007Ava RobinsonPayer Portal UnavailableSLA High75% AI
Medicaid NJ · Medicaid · Assigned to Sarah Mitchell · Updated 2026-04-22
Patient Name
Ava Robinson
Patient ID
PT-10048
Claim ID
CLM-1007
Visit ID
26005
Payer
Medicaid NJ
Payer ID
P00149
Carrier Plan
ASDPLANS12
Line of Business
Medicaid
Provider
Dr. Mira Chen
Provider NPI
1098765432
Billing Group
BILL2
Date of Service
2026-03-07
Charge Posted
2026-03-08
Charge Amount
$620.00
Paid Amount
$0.00
Adjusted Amount
$18.00
Insurance Balance
$604.00
Patient Balance
$16.00
Primary Payer
Medicaid NJ
Secondary Payer
N/A
Tertiary Payer
N/A
Crossover
No
Assigned To
Sarah Mitchell
SLA Target
24h
SLA Elapsed
48h
SLA Risk
High
AI Adjudication Recommendation
Retry Agent Tomorrow
75%
Retry Agent Tomorrow. Based on payer Medicaid NJ, reason codes, and historical patterns, recommended action with 75% confidence.
Evidence: reason codes none; payer history; matched 835 rule.
Risk flags: Possible duplicate visit
Suggested next action: Retry Agent Tomorrow