Payment integrity Source document
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Audit queue/ CLM-0000012/ Source document
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Source document

The claim as it was received

Availity clearinghouse · EDI 837P · received 02 Apr 2026 10:23 · 837P_20260402_194514.edi

Received
02 Apr 2026 10:23
Source
Availity clearinghouse · EDI 837P
File
837P_20260402_194514.edi
Interchange control
382383062
Claim control
CCN-3422575697
Storage
az://centene-audit/claims/2026/04/CLM-0000012.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-20260402-4113
Payment date 02 Apr 2026
Payer Centene
Payee Meridian Counseling Services
Payee NPI 1660271934
Billed $304.88
Allowed $304.88
Paid $304.88
Patient responsibility $0.00
The remittance matches the allowable on file. No variance identified.

Line detail

CodeBilled AllowedPaid Should have allowed
90837 $304.88 $304.88 $304.88 $304.88

835 segments

BPR*I*304.88*C*ACH*CCP*01*061000104*DA*0000*1234567890**01*021000021*DA*9876543210*20260402~
TRN*1*3528751213*1680000000~
DTM*405*20260402~
N1*PR*CENTENE~
N1*PE*MERIDIAN COUNSELING SERVICES*XX*1660271934~
LX*1~
CLP*CLM-0000012*1*304.88*304.88**CI*CCN-3422575697*11~