ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET
D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50%
CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED
CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ
CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓
300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS
WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20
EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20
PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓
ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET
D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50%
CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED
CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ
CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓
300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS
WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20
EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20
PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓
ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET
D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50%
CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED
CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ
CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓
300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS
WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20
EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20
PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓
ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET
D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50%
CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED
CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ
CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓
300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS
WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20
EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20
PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓
ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET
D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50%
CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED
CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ
CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓
300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS
WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20
EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20
PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓
ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET ELIGIBILITY ✓ ACTIVE PLAN PPO ANNUAL MAX $1,500 REMAINING $1,264 DED $50 MET
D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50% D0120 100% D1110 100% D2740 80% D4341 80% D4381 80% D6010 50% D8080 50%
CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED CLM-4731 ADJUDICATED PAID $842.00 CHK #59043 ERA 835 POSTED
CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ CLAIM STATUS RECEIVED → IN PROCESS → FINALIZED PAID $1,118.40 NO ACTION REQ
CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓ CO-45 $118.40 PR-2 $36.00 DENIAL OVERTURNED RESUBMITTED ✓
300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS 300+ PAYERS NORMALIZED BENEFITS CLAIM STATUS DENIALS
WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20 WAITING PERIOD NONE FREQ 2/12MO DOWNGRADE D2740 → D2751 COINS 80/20
EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20 EOB PARSED ALLOWED $96.00 WRITE-OFF $22.40 PATIENT $19.20
PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓ PA NOT REQUIRED COB PRIMARY TERMED 12/31 REVERIFIED ✓
