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Resolution Lab
CO186 Residual Balance on ED Visit

Marcus Johnson

MRN: MRN-5523104DOB: 1968-04-12Male, 58y
DOS
2026-07-03
Payer
Aetna Better Health
Claim
CLM-2026-4471932
Payer Balance
$990.00
Patient Resp
$0.00
Partially adjudicatedAccount: ACC-2026-884721

Patient Demographics

NameMarcus Johnson
MRNMRN-5523104
DOB1968-04-12
Age / Sex58 / Male

Account Summary

Account NumberACC-2026-884721
DOS2026-07-03
PayerAetna Better Health
PlanMedicare Advantage HMO
Claim NumberCLM-2026-4471932
Total Billed$4287.00
Current Payer Balance$990.00
Patient Responsibility$0.00
Claim StatusPartially adjudicated

Additional Context

Timely Filing

Claim submitted 3 days after DOS. Timely filing met.

Authorization

No authorization required for ED visit.

Coding / Provider

CPT 99285/25: ED visit, high complexity, with modifier 25 for significant separately identifiable E/M.

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