Overview
Cash collected, claims submitted, and payer balances.
Paid
Outstanding with payer
Denial rate
Submitted
Aging over 30 days
Avg days to payment
Book snapshot
Claims mix
Paid
Denied
In flight
Outstanding balance
Payer
Patient
Activity
Aetna · Service date May 9, 2026 · Dr. Samuel Ortiz
MRN MRN-PAT-GEN-72 · 62 yrs
No secondary insurance on file for this patient.
No non-insurance payers (foundations, grants, cash pay) are linked to this claim.
Credentialing status unavailable for this provider.
No referring or supervising providers are attached to this encounter.
No additional submission details (referral numbers, authorization numbers, accident information) on this claim.
Encounter-level place of service is the code on Box 24B of the CMS-1500. Per-line overrides appear in the Service lines table below.
| Date of service | CPT code | Modifiers | Diagnoses | Place of service | Qty | Billed | Details |
|---|---|---|---|---|---|---|---|
| May 9, 2026 | 70551 | — | M25.561 | 11 - Office | 1 | $2,200.00 | |
Allowed$1,452.00 Pri ins paym$1,306.80 Pri ins adj$748.00 Pat resp$145.20 Pat bal$145.20 Bal$145.20 | |||||||
| Check date | Check number | ERA ID |
|---|---|---|
| May 21, 2026 | W-520421 | era-20421 |
| Check date | Check number | Payer Claim ID |
|---|---|---|
| May 21, 2026 | W-520421 | — |
| Date of service | Facility | Status | Billed |
|---|---|---|---|
| Aug 23, 2026 | Northstar Family Health - Main | Paid | $230.00 |
| Jun 12, 2026 | Northstar Family Health - Main | Paid | $150.00 |
| Aug 15, 2026 | Northstar Family Health - Main | Paid | $400.00 |
| Jun 18, 2026 | Northstar Family Health - Main | ERA review | $400.00 |
| Jul 29, 2026 | Northstar Family Health - Main | Paid | $320.00 |
| Jul 22, 2026 | Northstar Family Health - Main | Paid | $1,800.00 |