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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   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
     
Member Info
General
Last Name: Brown
MI: E
Relationship: Wife
Status: Active
Citizenship: U.S. Citizen
Memo: This member has 4 instances.
First Name: Sue
Title: --
Gender: Female
Marital Status: Married
Race: White
DOB: 01/01/1972
Gender Identity: Female
Short Name: --
Ethnicity: Not Hispanic or Latino
Original Eff. Date: 01/01/2009
SSN: 253-45-3450
Suffix: 01
EDI Race & Eth. Source & Code --
Address Info
View all addresses
           
Notes
Style   Description   Updated On   Updated By
Application Notes   Claim Processing Notes   10/20/2018 08:59:123   FACETS
Claim Notes   Claim Notes   10/20/2018 08:28:558   FACETS

View Notes →
 
Home Address:
Subscriber Home
Address
Home:
12 Northeast New York Industrial Parkway
  Northeast New York Parkway University N
  Northeast New York PW University Apt 101
  NE Brownsboro Place, NY 10001-1101
County: Northeaster New York Country:United States
Phone: (718) 555-1234 Phone:(718) 555-9999 ext. 222
Email: sue.brown@gmail.com      
Cell Phone: (544) 564-5645
Language: English
Mailing Address
Subscriber Home
Address
Home:
12 Northeast New York Industrial Parkway
  Northeast New York Parkway University N
  Northeast New York PW University Apt 101
  NE Brownsboro Place, NY 10001-1101
County: Northeaster New York Country:United States
Phone: (718) 555-1234 Phone:(718) 555-9999 ext. 222
Email: sue.brown@gmail.com      
Work Phone: --
Confidential Comm.: Member
Work Address: Not Specified
Ext: --
Identifiers
Medicare No.: 8097761
Family Link ID: 2342365
Record No. 00000012815
Medicaid No.: 1234634
History Link ID: 4545646
Standard Unique Health ID: 123654789
HIPAA Certificate of Coverage
HIPAA Start Date: 01/01/1999
HIPAA End Date: 02/01/1999
   
PreExisting
Begin Date: 01/01/1999
Credit Days: 5
End Date: 02/01/1999
Limits: 5   10   44
Exclusionary Period Credit Days: 40
Applicant Information
Applicant Type: Timely
EOI Term. Date: 01/01/2000
Prior Billing Indicator: Y
Eligibility Date: 01/01/1999
New Signature Date: 01/01/1999
Prior Billing Eff. Date: 12/31/1998
Qualifying Event Date: 01/01/1999
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