EOBProcessed
Explanation of Benefits
Claim #CLM-2024-8841
Procedure99213 – Office Visit
Billed$320.00
Allowed$198.50
CO-45-$121.50
Patient Resp.$45.00
Paid$153.50
DENIALAction Needed
Claim Denied
Claim #CLM-2024-9012
Denial CodeCO-4
ReasonModifier inconsistency
ActionAdd Modifier -25
DeadlineAppeal by 12/15
EOBPosted
ERA Payment Summary
PayerBlue Cross
Check #ERA-88241
Total Paid$4,218.00
Claims12 processed
AdjustmentsCO-45, PR-2
DENIALAppeal Filed
Prior Auth Denied
CodeCO-197
ServiceMRI Lumbar Spine
ReasonAuth not obtained
LevelLevel 1 Appeal
ARQ4 Report
AR Aging Summary
0–30 days$42,180
31–60 days$18,440
61–90 days$9,210
90+ days$4,330
EOBReconciled
Medicare Remit
NPI1234567890
DOS11/20/2024
CPT93000 – EKG
Allowed$28.12
PR-2-$5.62
Paid$22.50
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