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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
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Retiree Subsidy
Carrier/Intermediary
Facilitator
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Transaction
Effective
Status
Last Update
Source
Batch ID
ADD
01/01/2020
01
10/07/2019 10:20
M
1
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Details
Name:
SUE3 SUE3
Medicare No:
SUE3-001
SSN:
Relationship to Retiree:
1 -Self
Gender:
F-Female
Application No:
Retiree Subsidy App No:
Unique Benefit Option Identifier:
Unique benefit id
Coverage Effective Date:
01/01/2017
Subsidy Period Termination Date:
Determination Indicator:
N
Response Reason Code:
User:
Default, Facets
Response:
Not assigned
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