{
  "payer": "Cascade Health Plan",
  "member_id": "CHP-88214307",
  "claim_number": "2026-183350021",
  "provider": "Lakeview Family Medicine",
  "date_processed": "2026-06-24",
  "lines": [
    {
      "date_of_service": "2026-06-02",
      "procedure_code": "99214",
      "description": "Office visit",
      "billed": 240,
      "allowed": 132.4,
      "plan_paid": 107.4,
      "patient_responsibility": 25,
      "remark_codes": [
        "CO-45",
        "PR-3"
      ]
    },
    {
      "date_of_service": "2026-06-02",
      "procedure_code": "80053",
      "description": "Metabolic panel",
      "billed": 88,
      "allowed": 21.6,
      "plan_paid": 21.6,
      "patient_responsibility": 0,
      "remark_codes": [
        "CO-45"
      ]
    },
    {
      "date_of_service": "2026-06-02",
      "procedure_code": "36415",
      "description": "Blood draw",
      "billed": 24,
      "allowed": 0,
      "plan_paid": 0,
      "patient_responsibility": 0,
      "remark_codes": [
        "CO-97"
      ]
    }
  ],
  "totals": {
    "billed": 352,
    "allowed": 154,
    "plan_paid": 129,
    "patient_responsibility": 25
  },
  "appeal_window": {
    "days": 180
  }
}