CLM-1009Mia YoungDeniedSLA High92% AI
Anthem · Commercial · Assigned to Laura Bennett · Updated 2026-04-22
Patient Name
Mia Young
Patient ID
PT-10050
Claim ID
CLM-1009
Visit ID
26007
Payer
Anthem
Payer ID
P00086
Carrier Plan
BCBSPPO
Line of Business
Commercial
Provider
Dr. Sasha Park
Provider NPI
1556677889
Billing Group
BILL5
Date of Service
2026-02-21
Charge Posted
2026-02-22
Charge Amount
$300.00
Paid Amount
$0.00
Adjusted Amount
$24.00
Insurance Balance
$262.00
Patient Balance
$38.00
Primary Payer
Anthem
Secondary Payer
N/A
Tertiary Payer
N/A
Crossover
No
Assigned To
Laura Bennett
SLA Target
24h
SLA Elapsed
48h
SLA Risk
High
AI Adjudication Recommendation
Correct Claim and Resubmit
92%
Correct Claim and Resubmit. Based on payer Anthem, reason codes, and historical patterns, recommended action with 92% confidence.
Evidence: reason codes CO16; payer history; matched 835 rule.
Risk flags: none
Suggested next action: Correct Claim and Resubmit