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Member ID: 53252345-01
  Name: Brown, Sue              
  • Benefit Summary 360
  • Overrides
  • COB
  • Match UM
  • EOB
  • Sign Payee
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     External ID: 9896695   Other Family Members: Yes
   
Other Family Members
Subscriber   Brown, Tom
Daughter   George-Brown, Mary Ann Elizabeth Isabella Penelope
Son   Brown, John
     
External ID
General
Primary External ID:
989669572033103810165028752448295755242906972017422935315770824171245137181780479222202823257256397288030377933351038691189817033955341752731117798596381532124613525009916395096904429554569704334283077223924710879085720279921426118977809749595876865037294
       
Additional External ID:
897878742713562101595377036134957526191182105025393856523713659987797580526919591713591742033577847445341128519157946380011556248460318849192349936340904997844833219051989889479398250502812496379149063681738950139938948927474052690682151949651821018952673
 
123456474613467467608909079528183084209547411246849824736044438110167328598337265777046602454152835056146944575854863849265399703395741664709717262476730934866191340389961276845755036991394218217078424333436631232631693926174065417204673857569152985441713
   
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