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Medicare Events
Member ID: 53252345-01
Name: Brown, Sue
Benefit Summary 360
Overrides
COB
Match UM
EOB
Sign Payee
New Medicare Member(Alt + F9)
Relationship:
Wife
Billing Information
Last Bill Date
08/01/2020
Net Amount Due
$1000.00
Current Suspense
$0
Processing Status
Normal Billing
DOB:
01/01/1972
Claims Information
Claim ID
Provider
Begin Date
Status
Total Charge
Claim Type
SubType
130670000100
Smith, Joe
01/01/2021
01 - Acce...
$1000.00
Medical
H
142500000200
Jones, Brian
02/15/2021
15 - Pend...
$200.00
Medical
M
130700000500
Smith, Joe
02/18/2021
11 - Pend...
$350.00
Medical
M
130900000600
Jones, Brian
03/21/2021
11 - Pend...
$250.00
Medical
M
Group:
G1234
Eff. Date:
01/01/2009
External ID:
9896695
Other Family Members:
Yes
Other Family Members
Subscriber
Brown, Tom
Daughter
George-Brown, Mary Ann Elizabeth Isabella Penelope
Son
Brown, John
Medicare
Events
Verifications
Interface
Retiree Subsidy
Carrier/Intermediary
Facilitator
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Event Code
Effective Date
Events
Effective
Medicare No.
State
County
PBP ID
Segment
Input
Verification
ABCDE
01/01/2020
LICS
01/01/2021
1EG5TE6MK89
California
Los Angeles
09/22/2022
BCDEF
01/01/2020
SCCC
01/01/2021
California
Los Angeles
09/22/2022
Verification Information
Event:
LIC Low Income Cost Subsidy
Effective:
01/01/2021
Last Verification
<
From:
01/01/2021
Thru:
01/01/2021
Result:
1 requirement Met
Institution ID:
--
Verified By:
Facets
Date:
02/03/2021
Method:
DOC Medicare Verification Reason 1
Reason:
0001 Medicare Verification Reason 1
View more recent medicare verifications
Verification Information
Event:
LIC Low Income Cost Subsidy
Effective:
01/01/2021
Last Verification
<
From:
01/01/2021
Thru:
01/01/2021
Result:
1 requirement Met
Institution ID:
--
Verified By:
Facets
Date:
02/03/2021
Method:
DOC Medicare Verification Reason 1
Reason:
0001 Medicare Verification Reason 1
View Details
CDEFG
01/01/2020
PRTA
01/01/2021
09/22/2022
DEFGH
01/01/2020
HICN
01/01/2021
1EG5TE6MK89
09/22/2022
EFGHI
01/01/2020
PBP
01/01/2021
001
123
09/22/2022
1
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Details
Event:
LICS (Low Income Cost Subsidy)
Part D Subsidy Level:
74.5
Effective Date:
01/01/2021
Copay Category:
5 Unknown
Termination Date:
--
Part D Subsidy Amount:
$74.50
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