All scenarios
IntroEligibilityDRAFT — sample content, pending author review
Covered yesterday, not today
CLM-100071Professional · 837P
Total billed
$198.00
- Member ID
- MBR-0026
- Plan
- Commercial PPO (illustrative)
- Eligibility
- Coverage terminated 2025-02-28 (loss of employment). Date of service is 2025-03-05 — after the termination date.
Member & Eligibility
- Name
- Maple Grove Primary Care
- NPI
- NPI-•••••2208
- Network
- In-network
- Specialty
- Internal Medicine
Provider
Service Lines
| # | DOS | CPT/HCPCS | Mods | ICD-10 | POS | Units | Charge |
|---|---|---|---|---|---|---|---|
| 1 | Mar 5, 2025 | 99214 | — | I10 | 11 — Office | 1 | $198.00 |
Prior Authorization
Not required.
Attachments & Notes
- •Eligibility file shows term date 2025-02-28; no reinstatement on record.
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.