All scenarios
IntroEligibility
The plan that ended before the visit
CLM-200131Professional · 837P
Total billed
$210.00
- Member ID
- MBR-2024
- Plan
- Commercial PPO (illustrative)
- Eligibility
- Eligibility check returns: this plan TERMINATED 2025-06-30. Patient's intake form lists a new plan effective 2025-07-01.
Member & Eligibility
- Name
- Riverside Internal Medicine (your client)
- NPI
- NPI-•••••5521
- Network
- In-network
- Specialty
- Internal Medicine
Provider
Service Lines
| # | DOS | CPT/HCPCS | Mods | ICD-10 | POS | Units | Charge |
|---|---|---|---|---|---|---|---|
| 1 | Jul 14, 2025 | 99214 | — | E11.9 | 11 — Office | 1 | $210.00 |
Prior Authorization
Not required.
Attachments & Notes
- •Claim is queued to bill the plan on file — the one that terminated 2025-06-30.
- •DOS is 2025-07-14, two weeks after that plan ended; the patient's new plan was effective 2025-07-01.
Front-desk flagged this on a worklist before billing. What's the right move before you submit?
Make the call. You'll see the rationale for your choice, then the teardown and the systems-level fix.
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