AI Adjudication Queue
AI recommendations on top of 837 scrubbing and 835 posting rules.
Showing 75 of 75 claims · 0 selected
| Claim | Patient | Payer / LOB | Charge | Paid | Status | SLA | Assigned | AI Recommendation | Conf. | Actions | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CLM-1001 v25998 | Emily Johnson PT-10042 | Premera Blue Cross Commercial | $369.00 | $200.00 | Paid Partial | Low | Michael Carter | Patient Balance PR2CO45 | 96% | ||
| CLM-1002 v25999 | William Anderson PT-10043 | Aetna Commercial | $1,240.00 | $0.00 | No Response | Medium | Sarah Mitchell | Start Payer Status Agent | 91% | ||
| CLM-1003 v26001 | Olivia Martinez PT-10044 | Blue Cross Blue Shield Commercial | $850.00 | $0.00 | Denied | High | Robert Hayes | Appeal / Request Documentation CO197 | 88% | ||
| CLM-1004 v26002 | James Wilson PT-10045 | United Healthcare Commercial | $450.00 | $300.00 | Paid Partial | Low | Laura Bennett | Bill Next PR2 | 94% | ||
| CLM-1005 v26003 | Sophia Clark PT-10046 | Cigna Commercial | $700.00 | $700.00 | Duplicate Suspected | Low | Unassigned | Hold | 98% | ||
| CLM-1006 v26004 | Benjamin Lewis PT-10047 | Medicare Medicare | $500.00 | $0.00 | Crossover Pending | Medium | Michael Carter | Monitor Crossover | 89% | ||
| CLM-1007 v26005 | Ava Robinson PT-10048 | Medicaid NJ Medicaid | $620.00 | $0.00 | Payer Portal Unavailable | High | Sarah Mitchell | Retry Agent Tomorrow | 75% | ||
| CLM-1008 v26006 | Henry Walker PT-10049 | Humana Medicare | $980.00 | $1,100.00 | Overpayment | Low | Robert Hayes | Human Review | 99% | ||
| CLM-1009 v26007 | Mia Young PT-10050 | Anthem Commercial | $300.00 | $0.00 | Denied | High | Laura Bennett | Correct Claim and Resubmit CO16 | 92% | ||
| CLM-1010 v26008 | Samuel Hall PT-10051 | Kaiser Commercial | $1,500.00 | $1,200.00 | PLB Adjustment | Medium | Unassigned | Provider Level Balance Review | 97% | ||
| CLM-1021 v26020 | Charlotte Allen PT-10052 | Premera Blue Cross Commercial | $880.00 | $470.00 | Paid Partial | Medium | Michael Carter | Auto-Post Approved CO45 | 95% | ||
| CLM-1022 v26021 | Daniel King PT-10053 | Medicare Medicare | $953.00 | $502.00 | No Response | Medium | Sarah Mitchell | Write Off Eligible | 87% |
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