Remittance
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Remittance Records · 18 participants · Click row to review · Click status to see details
| Medicaid ID | Participant | Start | End | Svc Code | Units | Billed | Paid | Status | Status Code | Action | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1234567890 | AKANA, KEONI(3) | 02/01 | 02/01 | T2025 | 4 | $250 | $250 | Paid | 1: Paid as billed... | ||
| 1234567891 | CHANG, LISA(2) | 02/01 | 02/01 | S5125 | 8 | $480 | $480 | Paid | 1: Paid as billed... | ||
| 1234567892 | FERNANDEZ, MARIA(2) | 02/02 | 02/02 | T2025 | 6 | $375 | $0 | Denied | CO-18: Duplicate claim/service... | ||
| 1234567893 | GONZALES, JUAN | 02/02 | 02/03 | S5125 | 4 | $240 | $240 | Paid | 1: Paid as billed... | ||
| 1234567894 | HONDA, YUKI(2) | 02/03 | 02/03 | T2025 | 8 | $500 | $0 | Denied | CO-29: Time limit for filing has expi... | ||
| 1234567895 | INOUE, TAKESHI | 02/03 | 02/04 | S5125 | 6 | $360 | $340 | Adjusted | ADJ: Payment adjusted per contract... | ||
| 1234567896 | JOHNSON, MICHAEL | 02/04 | 02/04 | T2025 | 4 | $250 | $250 | Paid | 1: Paid as billed... | ||
| 1234567897 | KALANI, MALIA(3) | 02/04 | 02/05 | S5125 | 8 | $480 | $0 | Voided | VOID: Claim voided at provider reque... | ||
| 1234567898 | LEE, DAVID | 02/05 | 02/05 | T2025 | 6 | $375 | $375 | Paid | 1: Paid as billed... | ||
| 1234567899 | MARTIN, SARAH | 02/05 | 02/05 | S5125 | 4 | $240 | $220 | Adjusted | ADJ: Payment adjusted per contract... | ||
| 1234567900 | NAKAMURA, YUKI | 02/05 | 02/06 | T2025 | 4 | $250 | $250 | Paid | 1: Paid as billed... | ||
| 1234567901 | ORTEGA, CARLOS | 02/05 | 02/05 | S5125 | 6 | $360 | $0 | Denied | CO-16: Claim lacks information or sub... | ||
| 1234567902 | PARK, JENNY | 02/06 | 02/06 | T2025 | 8 | $500 | $500 | Paid | 1: Paid as billed... | ||
| 1234567903 | QUINN, MICHAEL | 02/06 | 02/06 | S5125 | 4 | $240 | $0 | Voided | VOID: Claim voided at provider reque... | ||
| 1234567904 | REYES, ANA | 02/06 | 02/07 | T2025 | 6 | $375 | $375 | Paid | 1: Paid as billed... | ||
| 1234567905 | SANTOS, JOSE | 02/06 | 02/06 | S5125 | 4 | $240 | $0 | Denied | CO-4: Procedure code inconsistent wi... | ||
| 1234567906 | TANAKA, KENJI | 02/06 | 02/06 | T2025 | 8 | $500 | $500 | Paid | 1: Paid as billed... | ||
| 1234567907 | UEDA, MIKA | 02/06 | 02/07 | S5125 | 6 | $360 | $345 | Adjusted | ADJ: Payment adjusted per contract... |