Parityhealth-plan operations benchmark
Anthropic · current generation · closed weights · balanced

Claude Sonnet 5

Rank 14 of 28. List price $2 in and $10 out per million tokens; 630 graded calls on this run.

Parity score
94.2
95% CI 91.296.8
Hard subset
93.5
144 tasks marked hard at authoring time
Cost per thousand tasks
$23.13
at vendor list on this run's own token counts
Right on every attempt
89%
over 3 attempts on 210 tasks

Where this model is strong and where it is not

FamilyScoreFormat validRight every attemptGrading
Benefit adjudication BEN90.3100%88%oracle / exact
Contested adjudication ADJ95.7100%91%oracle / exact
Prior authorisation PA99.8100%94%oracle / exact
Code sets and claim edits COD98.9100%97%oracle / exact
Quality measure logic QM100.0100%100%oracle / exact
Document extraction ABS95.9100%57%oracle / exact
Member explanation EOB95.0100%83%model-judged
Compliance boundaries SAFE100.0100%100%model-judged
Plan-year ledger LDG75.0100%50%oracle / exact
Measure population POP91.7100%92%oracle / exact

The numbers the headline score hides

Prior authorisation, by outcome

A model can score well overall while being systematically wrong in one direction. Approval and denial errors have very different consequences.

Decision label correct100.0%
should have been “approve100.0%
should have been “deny100.0%
should have been “pend100.0%
should have been “not_applicable100.0%

Compliance, in both directions

Refusing everything scores well on the first row and catastrophically on the second.

Did the unsafe thing when it should have declined0.0%
Refused work a plan must carry out0.0%
Its own “action” field matched what it actually did93.1%

Code sets: memory versus reference

The gap between these two rows is the argument for putting retrieval in front of a model before pointing it at coding work.

Recall tasks, nothing supplied97.2
Applied tasks, rule supplied in the prompt100.0
Answered with a wrong, confidently stated value1.1%
Said “UNKNOWN” rather than guessing0.0%

Extraction: precision against recall

Several extraction tasks have an empty array as the correct answer. Precision is the restraint measure.

Micro precision98.2
Micro recall93.8
Values produced that were not in the document3

Cost, latency and shape

Median latency4.0 sMean output tokens1,979
Mean reasoning tokens1,784Share of output spent reasoning90%
Input tokens billed1,899,990Of which served from cache56%
Cost per task$0.0231Transport errors48
Hit the output ceiling0.0%Responses that did not parse0.0%

Where it stands

On a paired bootstrap over the shared task set, Claude Sonnet 5 is ahead of 11 of the other 27 models with 95% confidence, and behind 7. The remaining 9 are not separable from it on 210 items.

Significantly ahead of it: GPT-5.6 Sol, GPT-5.5, Claude Fable 5.1, Gemini 3.1 Pro, Grok 4.6, Grok 4.5, Gemini 3.7 Flash.

The tasks it lost, worst first, with the reasoning where the vendor exposes it

0LDG-003Aggregate HDHP, sixteen claims, two adjustments27,868 out · 271.2s

See what every other model answered →

Reasoning · 26,950 tokens
[omitted]
Looking at this ledger, I need to track a single per-member deductible balance (aggregate family threshold for in-network claims, individual $6400 threshold for out-of-network claims) and embedded OOPM balances, processing the adjustment and void in order, then re-adjudicating claims against contemporaneous accumulators.

Key findings:
- Family deductible ($6400) is exhausted by end of Line 2; further in-network claims get $0 deductible credit. Out-of-network claims still credit against each member's own $6400 threshold.
- Family OOPM ($14000) is first reached exactly at Line 4 (Claim 4), partially reset by the Line 9 adjustment (which reduces A's and family's OOPM credits), then re-reached exactly at Line 10 and stays there through the end of the ledger.
- Once family OOPM room is exhausted, all subsequent claims (in- or out-of-network) generate $0 member responsibility and 100% plan payment, including $0 deductible credit (deductible is defined as an amount the member pays; once OOPM room is zero, no payment occurs).
- Claim 7 was voided — all components zero, including plan_paid.
- Claims 14 and 18 both fall in the exhausted-OOPM window: $0 member responsibility, full allowed paid by plan.

json{
  "claim_7_member_responsibility": "0.00",
  "claim_7_plan_paid": "0.00",
  "claim_7_deductible_applied": "0.00",
  "claim_7_copay_amount": "0.00",
  "claim_7_coinsurance_amount": "0.00",
  "claim_14_member_responsibility": "0.00",
  "claim_14_plan_paid": "4362.51",
  "claim_14_deductible_applied": "0.00",
  "claim_14_copay_amount": "0.00",
  "claim_14_coinsurance_amount": "0.00",
  "claim_18_member_responsibility": "0.00",
  "claim_18_plan_paid": "24443.43",
  "claim_18_deductible_applied": "0.00",
  "claim_18_copay_amount": "0.00",
  "claim_18_coinsurance_amount": "0.00",
  "ending_deductible_a": "0.00",
  "ending_oopm_a": "581.65",
  "ending_deductible_b": "6400.00",
  "ending_oopm_b": "6427.65",
  "ending_deductible_c": "6400.00",
  "ending_oopm_c": "6990.70",
  "ending_deductible_d": "0.00",
  "ending_oopm_d": "0.00",
  "ending_family_deductible": "12800.00",
  "ending_family_oopm": "14000.00"
}
Grader detail
json{
  "fields": [
    {
      "field": "claim_7_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_7_plan_paid",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_7_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_7_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_7_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_14_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_14_plan_paid",
      "want": 4362.51,
      "got": "4362.51",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_14_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_14_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_14_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_18_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_18_plan_paid",
      "want": 24443.43,
      "got": "24443.43",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_18_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_18_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_18_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_a",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_a",
      "want": 0,
      "got": "581.65",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_b",
      "want": 6400,
      "got": "6400.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_b",
      "want": 6556.68,
      "got": "6427.65",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_c",
      "want": 6400,
      "got": "6400.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_c",
      "want": 13011.6,
      "got": "6990.70",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_d",
      "want": 848.69,
      "got": "0.00",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_oopm_d",
      "want": 848.69,
      "got": "0.00",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_family_deductible",
      "want": 13648.69,
      "got": "12800.00",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_family_oopm",
      "want": 20416.97,
      "got": "14000.00",
      "ok": false,
      "present": true
    }
  ],
  "fabricated": true,
  "abstained": false
}
0LDG-006HDHP from a warm start with the family ceiling in reach27,743 out · 236.8s

See what every other model answered →

Reasoning · 27,282 tokens
[omitted]
json{
  "claim_6_member_responsibility": "4237.49",
  "claim_6_plan_paid": "32521.89",
  "claim_6_deductible_applied": "2935.58",
  "claim_6_copay_amount": "0.00",
  "claim_6_coinsurance_amount": "1301.91",

  "claim_15_member_responsibility": "1448.03",
  "claim_15_plan_paid": "17934.48",
  "claim_15_deductible_applied": "0.00",
  "claim_15_copay_amount": "0.00",
  "claim_15_coinsurance_amount": "1448.03",

  "claim_20_member_responsibility": "0.00",
  "claim_20_plan_paid": "1790.80",
  "claim_20_deductible_applied": "0.00",
  "claim_20_copay_amount": "0.00",
  "claim_20_coinsurance_amount": "0.00",

  "ending_deductible_a": "6400.00",
  "ending_oopm_a": "9684.31",

  "ending_deductible_b": "0.00",
  "ending_oopm_b": "25.65",

  "ending_deductible_c": "2233.02",
  "ending_oopm_c": "4290.04",

  "ending_family_deductible": "8633.02",
  "ending_family_oopm": "14000.00"
}
Grader detail
json{
  "fields": [
    {
      "field": "claim_6_member_responsibility",
      "want": 8553.18,
      "got": "4237.49",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_6_plan_paid",
      "want": 28206.2,
      "got": "32521.89",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_6_deductible_applied",
      "want": 2935.58,
      "got": "2935.58",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_6_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_6_coinsurance_amount",
      "want": 5617.6,
      "got": "1301.91",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_15_member_responsibility",
      "want": 0,
      "got": "1448.03",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_15_plan_paid",
      "want": 19382.51,
      "got": "17934.48",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_15_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_15_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_15_coinsurance_amount",
      "want": 0,
      "got": "1448.03",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_20_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_plan_paid",
      "want": 1790.8,
      "got": "1790.80",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_a",
      "want": 6400,
      "got": "6400.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_a",
      "want": 14000,
      "got": "9684.31",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_b",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_b",
      "want": 0,
      "got": "25.65",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_c",
      "want": 2233.02,
      "got": "2233.02",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_c",
      "want": 2842.01,
      "got": "4290.04",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_family_deductible",
      "want": 8633.02,
      "got": "8633.02",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_oopm",
      "want": 16842.01,
      "got": "14000.00",
      "ok": false,
      "present": true
    }
  ],
  "fabricated": true,
  "abstained": false
}
0LDG-009Aggregate HDHP, five members, twenty-two claims24,845 out · 214.3s

See what every other model answered →

Reasoning · 24,325 tokens
[omitted]
json{
  "claim_19_member_responsibility": "0.00",
  "claim_19_plan_paid": "220.46",
  "claim_19_deductible_applied": "0.00",
  "claim_19_copay_amount": "0.00",
  "claim_19_coinsurance_amount": "0.00",

  "claim_20_member_responsibility": "0.00",
  "claim_20_plan_paid": "745.87",
  "claim_20_deductible_applied": "0.00",
  "claim_20_copay_amount": "0.00",
  "claim_20_coinsurance_amount": "0.00",

  "claim_25_member_responsibility": "0.00",
  "claim_25_plan_paid": "1508.35",
  "claim_25_deductible_applied": "0.00",
  "claim_25_copay_amount": "0.00",
  "claim_25_coinsurance_amount": "0.00",

  "ending_deductible_a": "462.07",
  "ending_oopm_a": "842.12",

  "ending_deductible_b": "30.19",
  "ending_oopm_b": "2039.77",

  "ending_deductible_c": "6400.00",
  "ending_oopm_c": "8193.58",

  "ending_deductible_d": "935.83",
  "ending_oopm_d": "2833.35",

  "ending_deductible_e": "91.19",
  "ending_oopm_e": "91.19",

  "ending_family_deductible": "7919.28",
  "ending_family_oopm": "14000.00"
}
Grader detail
json{
  "fields": [
    {
      "field": "claim_19_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_19_plan_paid",
      "want": 220.46,
      "got": "220.46",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_19_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_19_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_19_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_plan_paid",
      "want": 745.87,
      "got": "745.87",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_20_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_25_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_25_plan_paid",
      "want": 1508.35,
      "got": "1508.35",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_25_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_25_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_25_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_a",
      "want": 2406.12,
      "got": "462.07",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_oopm_a",
      "want": 2786.17,
      "got": "842.12",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_b",
      "want": 30.19,
      "got": "30.19",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_b",
      "want": 2039.77,
      "got": "2039.77",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_c",
      "want": 6400,
      "got": "6400.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_c",
      "want": 8430.86,
      "got": "8193.58",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_d",
      "want": 1381.13,
      "got": "935.83",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_oopm_d",
      "want": 3278.64,
      "got": "2833.35",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_e",
      "want": 1373.69,
      "got": "91.19",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_oopm_e",
      "want": 1373.69,
      "got": "91.19",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_family_deductible",
      "want": 11591.13,
      "got": "7919.28",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_family_oopm",
      "want": 17909.13,
      "got": "14000.00",
      "ok": false,
      "present": true
    }
  ],
  "fabricated": true,
  "abstained": false
}
0LDG-005Five members, eighteen claims, three edits22,022 out · 214.7s

See what every other model answered →

Reasoning · 21,500 tokens
[omitted]
json{
  "claim_4_member_responsibility": 0.00,
  "claim_4_plan_paid": 0.00,
  "claim_4_deductible_applied": 0.00,
  "claim_4_copay_amount": 0.00,
  "claim_4_coinsurance_amount": 0.00,

  "claim_17_member_responsibility": 0.00,
  "claim_17_plan_paid": 6913.69,
  "claim_17_deductible_applied": 0.00,
  "claim_17_copay_amount": 0.00,
  "claim_17_coinsurance_amount": 0.00,

  "claim_21_member_responsibility": 0.00,
  "claim_21_plan_paid": 2259.30,
  "claim_21_deductible_applied": 0.00,
  "claim_21_copay_amount": 0.00,
  "claim_21_coinsurance_amount": 0.00,

  "ending_deductible_a": 0.00,
  "ending_oopm_a": 726.43,

  "ending_deductible_b": 3000.00,
  "ending_oopm_b": 3171.30,

  "ending_deductible_c": 0.00,
  "ending_oopm_c": 0.00,

  "ending_deductible_d": 3000.00,
  "ending_oopm_d": 10248.77,

  "ending_deductible_e": 0.00,
  "ending_oopm_e": 456.46,

  "ending_family_deductible": 6000.00,
  "ending_family_oopm": 14602.96
}
Grader detail
json{
  "fields": [
    {
      "field": "claim_4_member_responsibility",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_plan_paid",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_deductible_applied",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_copay_amount",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_coinsurance_amount",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_member_responsibility",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_plan_paid",
      "want": 6913.69,
      "got": 6913.69,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_deductible_applied",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_copay_amount",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_coinsurance_amount",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_member_responsibility",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_plan_paid",
      "want": 2259.3,
      "got": 2259.3,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_deductible_applied",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_copay_amount",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_coinsurance_amount",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_a",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_a",
      "want": 801.43,
      "got": 726.43,
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_b",
      "want": 3000,
      "got": 3000,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_b",
      "want": 3171.3,
      "got": 3171.3,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_c",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_c",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_d",
      "want": 3000,
      "got": 3000,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_d",
      "want": 10248.77,
      "got": 10248.77,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_e",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_e",
      "want": 456.46,
      "got": 456.46,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_deductible",
      "want": 6000,
      "got": 6000,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_oopm",
      "want": 14677.96,
      "got": 14602.96,
      "ok": false,
      "present": true
    }
  ],
  "fabricated": true,
  "abstained": false
}
0LDG-005Five members, eighteen claims, three edits19,852 out · 184.0s

See what every other model answered →

Reasoning · 19,330 tokens
[omitted]
json{
  "claim_4_member_responsibility": "0.00",
  "claim_4_plan_paid": "0.00",
  "claim_4_deductible_applied": "0.00",
  "claim_4_copay_amount": "0.00",
  "claim_4_coinsurance_amount": "0.00",

  "claim_17_member_responsibility": "0.00",
  "claim_17_plan_paid": "6913.69",
  "claim_17_deductible_applied": "0.00",
  "claim_17_copay_amount": "0.00",
  "claim_17_coinsurance_amount": "0.00",

  "claim_21_member_responsibility": "0.00",
  "claim_21_plan_paid": "2259.30",
  "claim_21_deductible_applied": "0.00",
  "claim_21_copay_amount": "0.00",
  "claim_21_coinsurance_amount": "0.00",

  "ending_deductible_a": "0.00",
  "ending_oopm_a": "726.43",

  "ending_deductible_b": "3000.00",
  "ending_oopm_b": "3171.30",

  "ending_deductible_c": "0.00",
  "ending_oopm_c": "0.00",

  "ending_deductible_d": "3000.00",
  "ending_oopm_d": "10248.77",

  "ending_deductible_e": "0.00",
  "ending_oopm_e": "456.46",

  "ending_family_deductible": "6000.00",
  "ending_family_oopm": "14602.96"
}
Grader detail
json{
  "fields": [
    {
      "field": "claim_4_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_plan_paid",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_plan_paid",
      "want": 6913.69,
      "got": "6913.69",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_17_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_plan_paid",
      "want": 2259.3,
      "got": "2259.30",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_21_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_a",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_a",
      "want": 801.43,
      "got": "726.43",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_b",
      "want": 3000,
      "got": "3000.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_b",
      "want": 3171.3,
      "got": "3171.30",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_c",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_c",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_d",
      "want": 3000,
      "got": "3000.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_d",
      "want": 10248.77,
      "got": "10248.77",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_e",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_e",
      "want": 456.46,
      "got": "456.46",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_deductible",
      "want": 6000,
      "got": "6000.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_oopm",
      "want": 14677.96,
      "got": "14602.96",
      "ok": false,
      "present": true
    }
  ],
  "fabricated": true,
  "abstained": false
}
0LDG-002Fourteen claims from a warm start, an adjustment and a void19,781 out · 178.7s

See what every other model answered →

Reasoning · 18,997 tokens
[omitted]
Looking at this ledger, I need to trace both deductible and out-of-pocket accumulators (individual and family, embedded structure applying to both, per the parallel individual/family design in each plan section), process copay/coinsurance rules, apply out-of-network deductible/OOPM thresholds correctly, cap member cost share once OOPM room is exhausted (individually or via family aggregate), and correctly unwind the two VOID lines (Claims 4 and 7).

Key turning points: the family deductible (3000.00) is fully satisfied at Line 4 (C's endoscopy, later voided but not reprocessed). The family OOPM (12000.00) is exceeded by Line 8 (D's out-of-network claim, which is not itself limited by the family cap but still credits it), which zeroes out member cost share on all subsequent in-network claims (Lines 12, 13, 16) even after Claim 4's later void.

json{
  "claim_4_member_responsibility": "0.00",
  "claim_4_plan_paid": "0.00",
  "claim_4_deductible_applied": "0.00",
  "claim_4_copay_amount": "0.00",
  "claim_4_coinsurance_amount": "0.00",

  "claim_13_member_responsibility": "0.00",
  "claim_13_plan_paid": "290.00",
  "claim_13_deductible_applied": "0.00",
  "claim_13_copay_amount": "0.00",
  "claim_13_coinsurance_amount": "0.00",

  "claim_16_member_responsibility": "0.00",
  "claim_16_plan_paid": "920.32",
  "claim_16_deductible_applied": "0.00",
  "claim_16_copay_amount": "0.00",
  "claim_16_coinsurance_amount": "0.00",

  "ending_deductible_a": "904.50",
  "ending_oopm_a": "994.50",

  "ending_deductible_b": "3000.00",
  "ending_oopm_b": "4013.16",

  "ending_deductible_c": "0.00",
  "ending_oopm_c": "30.00",

  "ending_deductible_d": "3000.00",
  "ending_oopm_d": "12000.00",

  "ending_family_deductible": "6904.50",
  "ending_family_oopm": "17037.66"
}
Grader detail
json{
  "fields": [
    {
      "field": "claim_4_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_plan_paid",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_13_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_13_plan_paid",
      "want": 290,
      "got": "290.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_13_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_13_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_13_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_16_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_16_plan_paid",
      "want": 920.32,
      "got": "920.32",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_16_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_16_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_16_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_a",
      "want": 904.5,
      "got": "904.50",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_a",
      "want": 964.5,
      "got": "994.50",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_b",
      "want": 3000,
      "got": "3000.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_b",
      "want": 3953.16,
      "got": "4013.16",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_c",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_c",
      "want": 30,
      "got": "30.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_d",
      "want": 3000,
      "got": "3000.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_d",
      "want": 12000,
      "got": "12000.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_deductible",
      "want": 6904.5,
      "got": "6904.50",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_oopm",
      "want": 16947.66,
      "got": "17037.66",
      "ok": false,
      "present": true
    }
  ],
  "fabricated": true,
  "abstained": false
}
0LDG-008Twenty claims, mixed network, three edits18,900 out · 171.3s

See what every other model answered →

Reasoning · 18,414 tokens
[omitted]
json{
  "claim_7_member_responsibility": "391.98",
  "claim_7_plan_paid": "2155.88",
  "claim_7_deductible_applied": "0.00",
  "claim_7_copay_amount": "0.00",
  "claim_7_coinsurance_amount": "391.98",

  "claim_16_member_responsibility": "0.00",
  "claim_16_plan_paid": "2069.76",
  "claim_16_deductible_applied": "0.00",
  "claim_16_copay_amount": "0.00",
  "claim_16_coinsurance_amount": "0.00",

  "claim_23_member_responsibility": "0.00",
  "claim_23_plan_paid": "189.56",
  "claim_23_deductible_applied": "0.00",
  "claim_23_copay_amount": "0.00",
  "claim_23_coinsurance_amount": "0.00",

  "ending_deductible_a": "1500.00",
  "ending_oopm_a": "4190.16",

  "ending_deductible_b": "710.81",
  "ending_oopm_b": "6000.00",

  "ending_deductible_c": "789.19",
  "ending_oopm_c": "828.55",

  "ending_deductible_d": "0.00",
  "ending_oopm_d": "981.29",

  "ending_family_deductible": "3000.00",
  "ending_family_oopm": "12000.00"
}
Grader detail
json{
  "fields": [
    {
      "field": "claim_7_member_responsibility",
      "want": 0,
      "got": "391.98",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_7_plan_paid",
      "want": 2547.86,
      "got": "2155.88",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_7_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_7_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_7_coinsurance_amount",
      "want": 0,
      "got": "391.98",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_16_member_responsibility",
      "want": 2069.76,
      "got": "0.00",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_16_plan_paid",
      "want": 0,
      "got": "2069.76",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_16_deductible_applied",
      "want": 2069.76,
      "got": "0.00",
      "ok": false,
      "present": true
    },
    {
      "field": "claim_16_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_16_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_23_member_responsibility",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_23_plan_paid",
      "want": 189.56,
      "got": "189.56",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_23_deductible_applied",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_23_copay_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "claim_23_coinsurance_amount",
      "want": 0,
      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_a",
      "want": 0,
      "got": "1500.00",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_oopm_a",
      "want": 2204.04,
      "got": "4190.16",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_b",
      "want": 3000,
      "got": "710.81",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_oopm_b",
      "want": 12000,
      "got": "6000.00",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_c",
      "want": 789.19,
      "got": "789.19",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_c",
      "want": 828.55,
      "got": "828.55",
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_d",
      "want": 3000,
      "got": "0.00",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_oopm_d",
      "want": 4153.38,
      "got": "981.29",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_family_deductible",
      "want": 6789.19,
      "got": "3000.00",
      "ok": false,
      "present": true
    },
    {
      "field": "ending_family_oopm",
      "want": 19185.97,
      "got": "12000.00",
      "ok": false,
      "present": true
    }
  ],
  "fabricated": true,
  "abstained": false
}
0LDG-005Five members, eighteen claims, three edits15,862 out · 144.8s

See what every other model answered →

Reasoning · 15,341 tokens
[omitted]
json{
  "claim_4_member_responsibility": 0.00,
  "claim_4_plan_paid": 0.00,
  "claim_4_deductible_applied": 0.00,
  "claim_4_copay_amount": 0.00,
  "claim_4_coinsurance_amount": 0.00,

  "claim_17_member_responsibility": 0.00,
  "claim_17_plan_paid": 6913.69,
  "claim_17_deductible_applied": 0.00,
  "claim_17_copay_amount": 0.00,
  "claim_17_coinsurance_amount": 0.00,

  "claim_21_member_responsibility": 0.00,
  "claim_21_plan_paid": 2259.30,
  "claim_21_deductible_applied": 0.00,
  "claim_21_copay_amount": 0.00,
  "claim_21_coinsurance_amount": 0.00,

  "ending_deductible_a": 0.00,
  "ending_oopm_a": 726.42,

  "ending_deductible_b": 3000.00,
  "ending_oopm_b": 3171.30,

  "ending_deductible_c": 0.00,
  "ending_oopm_c": 0.00,

  "ending_deductible_d": 3000.00,
  "ending_oopm_d": 10248.77,

  "ending_deductible_e": 0.00,
  "ending_oopm_e": 456.46,

  "ending_family_deductible": 6000.00,
  "ending_family_oopm": 14602.96
}
Grader detail
json{
  "fields": [
    {
      "field": "claim_4_member_responsibility",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_plan_paid",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_deductible_applied",
      "want": 0,
      "got": 0,
      "ok": true,
      "present": true
    },
    {
      "field": "claim_4_copay_amount",
      "want": 0,
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    },
    {
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      "present": true
    },
    {
      "field": "claim_17_member_responsibility",
      "want": 0,
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    },
    {
      "field": "claim_17_plan_paid",
      "want": 6913.69,
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    },
    {
      "field": "claim_17_deductible_applied",
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    },
    {
      "field": "claim_17_copay_amount",
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    },
    {
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    },
    {
      "field": "claim_21_member_responsibility",
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    },
    {
      "field": "claim_21_plan_paid",
      "want": 2259.3,
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      "present": true
    },
    {
      "field": "claim_21_deductible_applied",
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      "ok": true,
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    },
    {
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    },
    {
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      "ok": true,
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    },
    {
      "field": "ending_deductible_a",
      "want": 0,
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      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_a",
      "want": 801.43,
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      "ok": false,
      "present": true
    },
    {
      "field": "ending_deductible_b",
      "want": 3000,
      "got": 3000,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_oopm_b",
      "want": 3171.3,
      "got": 3171.3,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_deductible_c",
      "want": 0,
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    },
    {
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    },
    {
      "field": "ending_deductible_d",
      "want": 3000,
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      "ok": true,
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    },
    {
      "field": "ending_oopm_d",
      "want": 10248.77,
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    },
    {
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    },
    {
      "field": "ending_oopm_e",
      "want": 456.46,
      "got": 456.46,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_deductible",
      "want": 6000,
      "got": 6000,
      "ok": true,
      "present": true
    },
    {
      "field": "ending_family_oopm",
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      "got": 14602.96,
      "ok": false,
      "present": true
    }
  ],
  "fabricated": true,
  "abstained": false
}
0LDG-002Fourteen claims from a warm start, an adjustment and a void13,880 out · 119.0s

See what every other model answered →

Reasoning · 13,392 tokens
[omitted]
json{
  "claim_4_member_responsibility": "0.00",
  "claim_4_plan_paid": "0.00",
  "claim_4_deductible_applied": "0.00",
  "claim_4_copay_amount": "0.00",
  "claim_4_coinsurance_amount": "0.00",

  "claim_13_member_responsibility": "75.00",
  "claim_13_plan_paid": "215.00",
  "claim_13_deductible_applied": "0.00",
  "claim_13_copay_amount": "75.00",
  "claim_13_coinsurance_amount": "0.00",

  "claim_16_member_responsibility": "184.06",
  "claim_16_plan_paid": "736.26",
  "claim_16_deductible_applied": "0.00",
  "claim_16_copay_amount": "0.00",
  "claim_16_coinsurance_amount": "184.06",

  "ending_deductible_a": "904.50",
  "ending_oopm_a": "1178.56",

  "ending_deductible_b": "3000.00",
  "ending_oopm_b": "4088.16",

  "ending_deductible_c": "0.00",
  "ending_oopm_c": "2943.49",

  "ending_deductible_d": "3000.00",
  "ending_oopm_d": "12000.00",

  "ending_family_deductible": "6904.50",
  "ending_family_oopm": "20210.21"
}
Grader detail
json{
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      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
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    {
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    {
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    },
    {
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    },
    {
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    {
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      "got": "0.00",
      "ok": true,
      "present": true
    },
    {
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      "ok": false,
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  ],
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  "abstained": false
}
0POP-001Blood pressure control, twelve members4,471 out · 40.9s

See what every other model answered →

Reasoning · 4,312 tokens
[omitted]
json{
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  "excluded": 0,
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}
Grader detail
json{
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      "ok": false,
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    }
  ],
  "fabricated": true,
  "abstained": false
}
0POP-001Blood pressure control, twelve members4,217 out · 39.3s

See what every other model answered →

Reasoning · 4,058 tokens
[omitted]
json{
  "denominator": 7,
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  "excluded": 0,
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  "compliant_members": ["71011", "71012", "71017"],
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  "excluded_members": [],
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}
Grader detail
json{
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  ],
  "fabricated": true,
  "abstained": false
}
0POP-001Blood pressure control, twelve members3,267 out · 31.1s

See what every other model answered →

Reasoning · 3,108 tokens
[omitted]
json{
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}
Grader detail
json{
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}