CLM-1010Samuel HallPLB AdjustmentSLA Medium97% AI
Kaiser · Commercial · Assigned to Unassigned · Updated 2026-04-22
Patient Name
Samuel Hall
Patient ID
PT-10051
Claim ID
CLM-1010
Visit ID
26008
Payer
Kaiser
Payer ID
P00087
Carrier Plan
AETHMO
Line of Business
Commercial
Provider
Dr. Jordan Reed
Provider NPI
1667788990
Billing Group
BILL2
Date of Service
2026-04-15
Charge Posted
2026-04-16
Charge Amount
$1,500.00
Paid Amount
$1,200.00
Adjusted Amount
$27.00
Insurance Balance
$251.00
Patient Balance
$49.00
Primary Payer
Kaiser
Secondary Payer
N/A
Tertiary Payer
N/A
Crossover
No
Assigned To
Unassigned
SLA Target
24h
SLA Elapsed
16h
SLA Risk
Medium
AI Adjudication Recommendation
Provider Level Balance Review
97%
Provider Level Balance Review. Based on payer Kaiser, reason codes, and historical patterns, recommended action with 97% confidence.
Evidence: reason codes none; payer history; matched 835 rule.
Risk flags: PLB
Suggested next action: Provider Level Balance Review
Hard errors: PLB