CLM-1008Henry WalkerOverpaymentSLA Low99% AI
Humana · Medicare · Assigned to Robert Hayes · Updated 2026-04-22
Patient Name
Henry Walker
Patient ID
PT-10049
Claim ID
CLM-1008
Visit ID
26006
Payer
Humana
Payer ID
P00085
Carrier Plan
ZipCarPl
Line of Business
Medicare
Provider
Dr. Anil Verma
Provider NPI
1122334455
Billing Group
BILL3
Date of Service
2026-02-28
Charge Posted
2026-03-01
Charge Amount
$980.00
Paid Amount
$1,100.00
Adjusted Amount
$21.00
Insurance Balance
$0.00
Patient Balance
$0.00
Primary Payer
Humana
Secondary Payer
N/A
Tertiary Payer
N/A
Crossover
No
Assigned To
Robert Hayes
SLA Target
24h
SLA Elapsed
48h
SLA Risk
Low
AI Adjudication Recommendation
Human Review
99%
Human Review. Based on payer Humana, reason codes, and historical patterns, recommended action with 99% confidence.
Evidence: reason codes none; payer history; matched 835 rule.
Risk flags: Overpayment
Suggested next action: Human Review
Hard errors: Overpayment