Claimsadjudication, explained

Members

Members & policies

Each member has their own editable policy. Open one to tune coverage rules and stage benefit usage, then submit claims to see every adjudication permutation.

New member
MemberPolicyDeductible usedClaims
Aisha KhanPlatinum Care
Plan year 2026
$0.00 / $250.00
0
Diego SantosBronze HDHP
Plan year 2026
$3000.00 / $3000.00
0
Lena ParkPlatinum Care
Plan year 2026
$0.00 / $250.00
0
Marcus ChenBronze HDHP
Plan year 2026
$1500.00 / $3000.00
0
Nia OkaforStandard PPO
Plan year 2026
$1000.00 / $1000.00
0
Priya SharmaStandard PPO
Plan year 2026
$1000.00 / $1000.00
1
Sam RiveraStandard PPO
Plan year 2026
$0.00 / $1000.00
0