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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
11/10/2022
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
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Transaction
Effective
Status
Last Update
Source
Batch ID
LICS
11/10/2022
01
09/30/2022
A
AC
11/10/2022
01
11/10/2022
M
CD
11/10/2022
01
11/10/2022
M
CN
11/10/2022
01
11/10/2022
M
PC
11/10/2022
01
11/10/2022
M
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Details
Reason:
Lorem Ipsum Dolores
County:
Lorem Ipsum Dolores
Signature Date:
Lorem Ipsum Dolores
Transaction Tracking ID:
Lorem Ipsum Dolores
Contract:
Lorem Ipsum Dolores
Election Type:
Lorem Ipsum Dolores
State:
PBP ID:
Lorem Ipsum Dolores
User:
Lorem Ipsum Dolores
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