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IntroDuplicatesDRAFT — sample content, pending author review
The claim that came back twice
CLM-100094Professional · 837P
Total billed
$175.00
- Member ID
- MBR-0031
- Plan
- Commercial PPO (illustrative)
- Eligibility
- Member eligible on the date of service.
Member & Eligibility
- Name
- Riverbend Pediatrics
- NPI
- NPI-•••••6614
- Network
- In-network
- Specialty
- Pediatrics
Provider
Service Lines
| # | DOS | CPT/HCPCS | Mods | ICD-10 | POS | Units | Charge |
|---|---|---|---|---|---|---|---|
| 1 | Jan 22, 2025 | 99392 | — | Z00.129 | 11 — Office | 1 | $175.00 |
Prior Authorization
Not required.
Attachments & Notes
- •History: CLM-100061 (same member, same provider, same DOS, same CPT) was received 2025-01-30 and PAID 2025-02-06. This claim (CLM-100094) was received 2025-02-20.
What is the correct disposition for this claim?
Make the call. You'll see the rationale for your choice, then the teardown and the systems-level fix.