φ(ai) PHI AI
DocumentationDocs
Repository
In context
Helen Tigist Marino MRN-232284 · born 1999-04-05 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-G0148307

Helen Tigist Marino MRN-232284 Payer UnitedHealthcare Service Mar 21, 2024 Status paid
$503.11
billed
$415.26
allowed
$301.61
paid
$28.88
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Office visit, established patient, level 499214 $184.63 $109.99
Office visit, new patient99204 $318.48 $191.62