Medicare Advantage
Anthem Extras
Medicare Supplement
PDP
100

HCID: 813W15730

What is the plan name?

Anthem MediBlue Service PPO

MO H4909-02100

100

HCID: 356W04558 

What is the plan name?

Premium Plus Package without Silver Sneakers

100

HCID: 770W16941

What is the member's Premium Amount?

$318.63

100

HCID: 819W16921

What is the member's name?

Cindy Thomas

200

HCID: 813W15730

What is the payment method?

Monthly Check/ Check

200

HCID: 356W04558 

What's the billing status? 

Outstanding pending payment

200

HCID: 770W16941

What is the Alpha Prefix?

YLM

200

HCID: 819W16921

Who is the AOR?

Barbara Louhoff

300

HCID: 813W15730

What is the LEP?

There is NONE

300

HCID: 356W04558 

What is their coverage type?

Employee Only

300

HCID: 770W16941

For claim ID 250837456900, what is the status and what is the billed amount?

Status is: ACCEPTED

Billed amount: $200.00

300

HCID: 819W16921

How was the app submitted?

Through the online store

400

HCID: 813W15730

What was the last invoice date and the payment status?

Invoice date 04/17/2023. 

Status is UNPAID

400

HCID: 356W04558 

When was the app received? 

07/21/2023

400

HCID: 770W16941

For claim 250837456900, what is the Disallow Reason (23) in line 1?

The impact of prior payer adjudication including payments or adjustments

400

HCID: 819W16921

What is the Tolerance Percent?

20%