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
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Outstanding balance
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Patient
Activity
Aetna · Service date Jun 15, 2026 · Dr. Samuel Ortiz
MRN MRN-PAT-GEN-185 · 75 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 |
|---|---|---|---|---|---|---|---|
| Jun 15, 2026 | 20610 | — | J30.9 | 11 - Office | 1 | $420.00 | |
Allowed$277.20 Pri ins paym$249.48 Pri ins adj$142.80 Pat resp$27.72 Pat bal$27.72 Bal$27.72 | |||||||
| Check date | Check number | ERA ID |
|---|---|---|
| Jun 27, 2026 | W-521085 | era-21085 |
| Check date | Check number | Payer Claim ID |
|---|---|---|
| Jun 27, 2026 | W-521085 | — |
| Date of service | Facility | Status | Billed |
|---|---|---|---|
| Aug 14, 2026 | Northstar Family Health - Main | Awaiting info | $2,400.00 |
| May 26, 2026 | Northstar Family Health - Main | Paid | $4,800.00 |