HCID: 813W15730
What is the plan name?
Anthem MediBlue Service PPO
MO H4909-02100
HCID: 356W04558
What is the plan name?
Premium Plus Package without Silver Sneakers
HCID: 770W16941
What is the member's Premium Amount?
$318.63
HCID: 819W16921
What is the member's name?
Cindy Thomas
HCID: 813W15730
What is the payment method?
Monthly Check/ Check
HCID: 356W04558
What's the billing status?
Outstanding pending payment
HCID: 770W16941
What is the Alpha Prefix?
YLM
HCID: 819W16921
Who is the AOR?
Barbara Louhoff
HCID: 813W15730
What is the LEP?
There is NONE
HCID: 356W04558
What is their coverage type?
Employee Only
HCID: 770W16941
For claim ID 250837456900, what is the status and what is the billed amount?
Status is: ACCEPTED
Billed amount: $200.00
HCID: 819W16921
How was the app submitted?
Through the online store
HCID: 813W15730
What was the last invoice date and the payment status?
Invoice date 04/17/2023.
Status is UNPAID
HCID: 356W04558
When was the app received?
07/21/2023
HCID: 770W16941
For claim 250837456900, what is the Disallow Reason (23) in line 1?
The impact of prior payer adjudication including payments or adjustments
HCID: 819W16921
What is the Tolerance Percent?
20%