Claude Opus 4.8
Rank 13 of 28. List price $5 in and $25 out per million tokens; 630 graded calls on this run.
Parity score
94.2
95% CI 91.4–96.7
Hard subset
93.9
144 tasks marked hard at authoring time
Cost per thousand tasks
$42.29
at vendor list on this run's own token counts
Right on every attempt
90%
over 3 attempts on 210 tasks
Where this model is strong and where it is not
| Family | Score | Format valid | Right every attempt | Grading |
|---|---|---|---|---|
| Benefit adjudication BEN | 97.2 | 100% | 92% | oracle / exact |
| Contested adjudication ADJ | 98.6 | 100% | 96% | oracle / exact |
| Prior authorisation PA | 99.2 | 100% | 88% | oracle / exact |
| Code sets and claim edits COD | 96.7 | 100% | 97% | oracle / exact |
| Quality measure logic QM | 92.0 | 100% | 92% | oracle / exact |
| Document extraction ABS | 97.2 | 100% | 71% | oracle / exact |
| Member explanation EOB | 97.5 | 100% | 92% | model-judged |
| Compliance boundaries SAFE | 97.2 | 100% | 96% | model-judged |
| Plan-year ledger LDG | 66.7 | 100% | 50% | oracle / exact |
| Measure population POP | 100.0 | 100% | 100% | 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 correct | 100.0% |
| should have been “approve” | 100.0% |
| should have been “deny” | 100.0% |
| should have been “pend” | 100.0% |
| should have been “not_applicable” | 100.0% |
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 declined | 0.0% |
| Refused work a plan must carry out | 5.6% |
| Its own “action” field matched what it actually did | 98.6% |
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 supplied | 91.7 |
| Applied tasks, rule supplied in the prompt | 100.0 |
| Answered with a wrong, confidently stated value | 3.3% |
| Said “UNKNOWN” rather than guessing | 0.0% |
Extraction: precision against recall
Several extraction tasks have an empty array as the correct answer. Precision is the restraint measure.
| Micro precision | 100.0 |
| Micro recall | 95.0 |
| Values produced that were not in the document | 0 |
Cost, latency and shape
| Median latency | 2.3 s | Mean output tokens | 1,315 |
| Mean reasoning tokens | 1,051 | Share of output spent reasoning | 80% |
| Input tokens billed | 1,898,838 | Of which served from cache | 50% |
| Cost per task | $0.0423 | Transport errors | 48 |
| Hit the output ceiling | 0.0% | Responses that did not parse | 0.0% |
Where it stands
On a paired bootstrap over the shared task set, Claude Opus 4.8 is ahead of 10 of the other 27 models with 95% confidence, and behind 8. 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, Claude Opus 5, 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-012Twenty-four claims on an HDHP from a warm start30,564 out · 378.6s
See what every other model answered →
Reasoning · 29,891 tokens
[omitted]Looking at this ledger, key facts: AGGREGATE deductible (family 6400, met at Line 1), then 10% in-network / 40% OON coinsurance. OON claims measure the member's single deductible balance against 6400. Per the plan text, the 100% trigger is per-member individual OOPM (7000 in-network / 14000 OON); family OOP is an uncapped running total. Claim 6 is voided; Claim 22 is A's crossing of the 7000 in-network OOPM; Claim 28 lands with A already at OOPM.
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"claim_22_member_responsibility": "433.46",
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"ending_oopm_b": "12509.05",
"ending_deductible_c": "1229.85",
"ending_oopm_c": "1928.02",
"ending_deductible_d": "3560.42",
"ending_oopm_d": "4345.31",
"ending_family_deductible": "14931.13",
"ending_family_oopm": "25782.38"
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Grader detail
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},
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},
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},
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},
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},
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"abstained": false
}0LDG-004Copays that credit the deductible, fifteen claims27,644 out · 328.0s
See what every other model answered →
Reasoning · 26,967 tokens
[omitted]Looking at this ledger, the key dynamics are: the family deductible is met at Line 2 (so later in-network deductible_applied = 0 via the embedded rule), members hit individual OOPMs per network, and the doc explicitly says balances are NOT capped at in-network amounts — so B's OON claim pushing the family balance past 11000 does not zero out in-network cost share. Individual OOPM triggers 100% per member/network.
Key results: C hits in-network OOPM at Line 1 and OON OOPM at Line 10; B hits OOPM at Line 4; A never reaches OOPM, so Claim 6 retains its urgent-care copay through both adjustments.
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"ending_oopm_c": 11000.00,
"ending_family_deductible": 12955.81,
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Grader detail
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"want": 0,
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"ok": true,
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"field": "ending_oopm_b",
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"field": "ending_deductible_c",
"want": 5000,
"got": 5000,
"ok": true,
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},
{
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"ok": true,
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},
{
"field": "ending_family_deductible",
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"got": 12955.81,
"ok": true,
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},
{
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"ok": false,
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],
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"abstained": false
}0LDG-012Twenty-four claims on an HDHP from a warm start24,455 out · 274.6s
See what every other model answered →
Reasoning · 23,718 tokens
[omitted]Looking at this ledger, I tracked an aggregate deductible (family met at Line 1) with in-network claims measured against the family remainder and OON claims against each member's single balance vs. the 6400 OON threshold. The 100% payment trigger fires at each member's individual OOPM (7000 in-network / 14000 OON) using their combined balance.
Key points:
- Claim 6 is voided at Line 24 → all components 0.
- Claim 22 (A): coinsurance would be 886.13, but A's in-network OOPM cap leaves only 433.46 of room (6566.54 → 7000.00), so member pays 433.46.
- Claim 28 (A): A is already at the 7000 in-network OOPM → plan pays 100%.
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"claim_22_member_responsibility": 433.46,
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"claim_28_member_responsibility": 0.00,
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"ending_oopm_d": 4345.31,
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Grader detail
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"want": 0,
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"ok": true,
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},
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},
{
"field": "ending_deductible_b",
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},
{
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},
{
"field": "ending_deductible_c",
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},
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"want": 1308.18,
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},
{
"field": "ending_deductible_d",
"want": 3560.42,
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"ok": true,
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},
{
"field": "ending_oopm_d",
"want": 4193.22,
"got": 4345.31,
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},
{
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"ok": true,
"present": true
},
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"ok": false,
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],
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}0LDG-002Fourteen claims from a warm start, an adjustment and a void20,906 out · 247.0s
See what every other model answered →
Reasoning · 20,167 tokens
[omitted]Looking at this, the key judgment is that the plan document's 100% rule is stated only for "a member reaching the out-of-pocket maximum" (the individual OOPM against the applicable in-network/OON threshold). The addendum warns that OON claims inflate family balances past the family amount and that balances are not capped — so I do not treat the family balance exceeding 12000 as a 100% trigger. Family deductible being met, however, stops all further deductible under the embedded rule.
Key results: Claim 4 is voided (all 0). Claim 13 is an urgent-care copay (family deductible already met, copay applies). Claim 16 (allergy testing for A) hits no deductible because the family deductible is fully satisfied, so it goes straight to 20% coinsurance.
json{
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"claim_4_coinsurance_amount": "0.00",
"claim_13_member_responsibility": "75.00",
"claim_13_plan_paid": "215.00",
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"claim_13_coinsurance_amount": "0.00",
"claim_16_member_responsibility": "184.06",
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"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",
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"ending_oopm_b": "4088.16",
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"ending_oopm_c": "2943.49",
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"ending_oopm_d": "12000.00",
"ending_family_deductible": "6904.50",
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}
Grader detail
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"want": 0,
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},
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},
{
"field": "ending_deductible_a",
"want": 904.5,
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{
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"field": "ending_deductible_b",
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"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 3953.16,
"got": "4088.16",
"ok": false,
"present": true
},
{
"field": "ending_deductible_c",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 30,
"got": "2943.49",
"ok": false,
"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": "20210.21",
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-012Twenty-four claims on an HDHP from a warm start19,969 out · 243.3s
See what every other model answered →
Reasoning · 19,288 tokens
[omitted]Looking at this ledger, the key dynamics are: the family deductible (aggregate, 6400) is met at Line 1; from then only coinsurance applies in-network. The family OOPM (14000) is the ceiling on total family member cost share and is reached at Line 11, so subsequent claims are paid 100% until a void drops the family OOP below 14000, at which point cost share resumes and quickly re-tops the ceiling.
Claim 6 is voided (Line 24); Claims 22 and 28 are processed while the family OOPM is at 14000, so the plan pays 100%.
json{
"claim_6_member_responsibility": 0.00,
"claim_6_plan_paid": 0.00,
"claim_6_deductible_applied": 0.00,
"claim_6_copay_amount": 0.00,
"claim_6_coinsurance_amount": 0.00,
"claim_22_member_responsibility": 0.00,
"claim_22_plan_paid": 8861.27,
"claim_22_deductible_applied": 0.00,
"claim_22_copay_amount": 0.00,
"claim_22_coinsurance_amount": 0.00,
"claim_28_member_responsibility": 0.00,
"claim_28_plan_paid": 7571.23,
"claim_28_deductible_applied": 0.00,
"claim_28_copay_amount": 0.00,
"claim_28_coinsurance_amount": 0.00,
"ending_deductible_a": 3740.86,
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"ending_oopm_b": 5755.03,
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"ending_oopm_c": 1915.74,
"ending_deductible_d": 662.41,
"ending_oopm_d": 1295.21,
"ending_family_deductible": 11120.27,
"ending_family_oopm": 14000.00
}
Grader detail
json{
"fields": [
{
"field": "claim_6_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
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},
{
"field": "claim_6_plan_paid",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_6_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_6_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_6_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_22_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_22_plan_paid",
"want": 8861.27,
"got": 8861.27,
"ok": true,
"present": true
},
{
"field": "claim_22_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_22_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_22_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_plan_paid",
"want": 7571.23,
"got": 7571.23,
"ok": true,
"present": true
},
{
"field": "claim_28_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 3740.86,
"got": 3740.86,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 4638.07,
"got": 5034.02,
"ok": false,
"present": true
},
{
"field": "ending_deductible_b",
"want": 6400,
"got": 5487.15,
"ok": false,
"present": true
},
{
"field": "ending_oopm_b",
"want": 12509.05,
"got": 5755.03,
"ok": false,
"present": true
},
{
"field": "ending_deductible_c",
"want": 1229.85,
"got": 1229.85,
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 1308.18,
"got": 1915.74,
"ok": false,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3560.42,
"got": 662.41,
"ok": false,
"present": true
},
{
"field": "ending_oopm_d",
"want": 4193.22,
"got": 1295.21,
"ok": false,
"present": true
},
{
"field": "ending_family_deductible",
"want": 14931.13,
"got": 11120.27,
"ok": false,
"present": true
},
{
"field": "ending_family_oopm",
"want": 22648.52,
"got": 14000,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-009Aggregate HDHP, five members, twenty-two claims19,041 out · 225.9s
See what every other model answered →
Reasoning · 18,274 tokens
[omitted]Looking at this ledger, the key dynamics are: the family deductible (6400 aggregate) is satisfied by Claim 2's out-of-network deductible credit, so all later in-network claims skip the deductible and go straight to coinsurance; and the family out-of-pocket maximum (14000) is repeatedly reached, capping member responsibility, with the two voids (Claims 3, 6) each temporarily reopening room that the next out-of-network claim exactly refills. By Line 17 the family OOPM is reached and stays reached (Claim 20's adjustment removes no credits since it is preventive), so Claims 19, 20, and 25 are all paid at 100%. Claim 20 is an in-network routine immunisation (preventive) regardless.
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",
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"ending_oopm_c": "8193.58",
"ending_deductible_d": "935.83",
"ending_oopm_d": "2833.34",
"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",
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"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": "2833.34",
"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-006HDHP from a warm start with the family ceiling in reach14,817 out · 156.0s
See what every other model answered →
Reasoning · 14,357 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-005Five members, eighteen claims, three edits14,774 out · 169.1s
See what every other model answered →
Reasoning · 14,110 tokens
[omitted]Looking at this ledger, the key driver is the out-of-network inpatient claim (Line 1) generating 10248.77 of member responsibility, which — combined with the explicit rule that OON credits accumulate to the family balance — drives the family OOPM (12000) to be reached at Line 6. After that, in-network claims pay at 100%, while the OON claim at Line 8 still carries OON cost share (measured only against OON thresholds).
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,
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"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-009Aggregate HDHP, five members, twenty-two claims12,817 out · 143.5s
See what every other model answered →
Reasoning · 12,295 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",
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}
Grader detail
json{
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},
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},
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},
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},
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},
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},
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},
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},
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},
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"field": "claim_25_member_responsibility",
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},
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},
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},
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"field": "claim_25_copay_amount",
"want": 0,
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"present": true
},
{
"field": "claim_25_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
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"want": 2406.12,
"got": "462.07",
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},
{
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"want": 2786.17,
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},
{
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"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": "2833.34",
"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 edits11,850 out · 134.7s
See what every other model answered →
Reasoning · 11,216 tokens
[omitted]Looking at this ledger, the key inflection is Line 1: D's out-of-network inpatient claim credits 3000.00 to the family deductible balance, which under the embedded structure satisfies the entire family deductible. Line 6 then pushes the family OOPM to 12000.00, so all subsequent in-network claims are paid at 100%.
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"claim_17_member_responsibility": 0.00,
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}
Grader detail
json{
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},
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},
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"field": "claim_21_member_responsibility",
"want": 0,
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},
{
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},
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},
{
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"want": 0,
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},
{
"field": "claim_21_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 0,
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},
{
"field": "ending_oopm_a",
"want": 801.43,
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},
{
"field": "ending_deductible_b",
"want": 3000,
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},
{
"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 edits10,923 out · 121.6s
See what every other model answered →
Reasoning · 10,202 tokens
[omitted]Looking at this ledger, the critical events are: Claim 1 (OON) posts a 3000.00 deductible credit and 10248.77 to the family OOP, and Claim 6 pushes the family OOP to the 12000.00 family OOPM. Once the family OOPM is met, all subsequent in-network covered services are paid 100% (member 0.00). OON Claim 8 is measured against B's separate OON thresholds. The adjustments to Claims 5 and 2 re-adjudicate against accumulators with the family OOPM already met, so both re-price to 0.00; Claim 4 is voided.
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}
Grader detail
json{
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},
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},
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},
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"field": "claim_21_member_responsibility",
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},
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},
{
"field": "claim_21_copay_amount",
"want": 0,
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},
{
"field": "claim_21_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
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},
{
"field": "ending_deductible_a",
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"got": 0,
"ok": true,
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},
{
"field": "ending_oopm_a",
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},
{
"field": "ending_deductible_b",
"want": 3000,
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},
{
"field": "ending_oopm_b",
"want": 3171.3,
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"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-006HDHP from a warm start with the family ceiling in reach9,861 out · 105.3s
See what every other model answered →
Reasoning · 9,400 tokens
[omitted]json{
"claim_6_member_responsibility": "8553.18",
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"claim_6_deductible_applied": "2935.58",
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"claim_15_member_responsibility": "1938.25",
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"claim_15_coinsurance_amount": "1938.25",
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}
Grader detail
json{
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},
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},
{
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},
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},
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},
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},
{
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},
{
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},
{
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},
{
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},
{
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},
{
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},
{
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},
{
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},
{
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},
{
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}
],
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}