All claims
Claim CLM-500
Priya Sharma · Policy POL-100 · Submitted June 8, 2026
Under reviewAwaiting a manual decision before payment.
Awaiting a manual decision before payment.
Billed Total charged across all line items.
$3200.00Insurer pays The plan’s total share for this claim.
$400.00Member owes The member's share: deductible + cost-share + anything not covered.
$1050.00Line items
Each line is adjudicated on its own. Click a row to see where the money goes and how the decision was made.
ServiceBilledAllowedInsurer paysMember owesStatus
Benefits used
Running totals for Priya Sharma. These drive when the deductible is met and when a benefit limit is exhausted.
Deductible The member pays toward this each year before the plan starts paying for deductible-eligible services.$1000.00 / $1000.00
Fully used — further charges to this benefit aren’t covered.
Out-of-pocket max The most the member pays per year for covered services (deductible + copays + coinsurance). Once reached, the plan pays 100% of further covered costs.$250.00 / $5000.00
Physical therapy — annual limit The plan covers this benefit up to a yearly cap; amounts above the cap are the member’s responsibility.$2000.00 / $2000.00
Fully used — further charges to this benefit aren’t covered.
Lifecycle
Every state change is recorded — submission, adjudication, review, disputes, and payment.
- ClaimSubmitted → Under reviewSUBMIT
- Line itemSubmitted → ApprovedADJUDICATE
- Line itemSubmitted → ApprovedADJUDICATE
- Line itemSubmitted → Partially approvedADJUDICATE
- Line itemSubmitted → DeniedADJUDICATE
- Line itemSubmitted → Under reviewADJUDICATE