φ(ai) PHI AI
DocumentationDocs
Repository
In context
Charline Paucek MRN-101495 · born 1975-08-28 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-2026185001

Charline Paucek MRN-101495 Payer UnitedHealthcare Service Dec 23, 2025 Status paid
$129.94
billed
$90.96
allowed
$0.00
paid
$90.96
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
tropicamide 5 MG/ML Ophthalmic Solution313521 $0.00 $0.00