CLM-1021Charlotte AllenPaid PartialSLA Medium95% AI
Premera Blue Cross · Commercial · Assigned to Michael Carter · Updated 2026-04-22
Patient Name
Charlotte Allen
Patient ID
PT-10052
Claim ID
CLM-1021
Visit ID
26020
Payer
Premera Blue Cross
Payer ID
P00244
Carrier Plan
UNITEDHEQ6
Line of Business
Commercial
Provider
Dr. Leo Yonda
Provider NPI
1234567890
Billing Group
BILL3
Date of Service
2026-04-08
Charge Posted
2026-04-09
Charge Amount
$880.00
Paid Amount
$470.00
Adjusted Amount
$30.00
Insurance Balance
$400.00
Patient Balance
$10.00
Primary Payer
Premera Blue Cross
Secondary Payer
N/A
Tertiary Payer
N/A
Crossover
No
Assigned To
Michael Carter
SLA Target
24h
SLA Elapsed
30h
SLA Risk
Medium
AI Adjudication Recommendation
Auto-Post Approved
95%
Auto-Post Approved. Based on payer Premera Blue Cross, reason codes, and historical patterns, recommended action with 95% confidence.
Evidence: reason codes CO45; payer history; matched 835 rule.
Risk flags: none
Suggested next action: Auto-Post Approved