Payment integrity Source document
Centene · payment integrity
Audit queue/ CLM-0000008/ Source document
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Source document

The claim as it was received

Availity clearinghouse · EDI 837P · received 23 Mar 2026 08:16 · 837P_20260323_174013.edi

Received
23 Mar 2026 08:16
Source
Availity clearinghouse · EDI 837P
File
837P_20260323_174013.edi
Interchange control
210017053
Claim control
CCN-1436910325
Storage
az://centene-audit/claims/2026/03/CLM-0000008.edi

Generated from the claim record on request — no file is stored. The storage path above is the hook for real blob storage; once wired it is what would be handed to the agent's document_uri input.

Claim form CMS-1500 (02/12) As received Fax image, 200 dpi EDI 837P 005010X222A1 Remittance EDI 835

What was paid

Check / EFT EFT-20260401-4329
Payment date 01 Apr 2026
Payer Centene
Payee Meridian Counseling Services
Payee NPI 1660271934
Billed $152.44
Allowed $152.44
Paid $152.44
Patient responsibility $0.00
The remittance matches the allowable on file. No variance identified.

Line detail

CodeBilled AllowedPaid Should have allowed
90837 $152.44 $152.44 $152.44 $152.44

835 segments

BPR*I*152.44*C*ACH*CCP*01*061000104*DA*0000*1234567890**01*021000021*DA*9876543210*20260401~
TRN*1*9300131101*1680000000~
DTM*405*20260401~
N1*PR*CENTENE~
N1*PE*MERIDIAN COUNSELING SERVICES*XX*1660271934~
LX*1~
CLP*CLM-0000008*1*152.44*152.44**CI*CCN-1436910325*11~