All scenarios
IntroMember Cost-Share
The copay that shouldn't be there
CLM-100428Professional · 837P
Total billed
$240.00
- Member ID
- MBR-0202
- Plan
- Commercial PPO (illustrative) — ACA-compliant
- Eligibility
- Member eligible. Plan applies in-network preventive services at $0 member cost-share per the plan's preventive benefit.
Member & Eligibility
- Name
- Lakeshore Internal Medicine
- NPI
- NPI-•••••2204
- Network
- In-network
- Specialty
- Internal Medicine
Provider
Service Lines
| # | DOS | CPT/HCPCS | Mods | ICD-10 | POS | Units | Charge |
|---|---|---|---|---|---|---|---|
| 1 | Jun 3, 2025 | 99396 | 33 | Z00.00 | 11 — Office | 1 | $240.00 |
Prior Authorization
Not required for this service.
Attachments & Notes
- •Claim auto-applied a $30 office-visit copay to the member.
- •Line carries modifier 33 (preventive) and a routine-exam diagnosis (Z00.00).
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.
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