Payment integrity Source document
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Audit queue/ CLM-0000021/ Source document
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Source document

The claim as it was received

Availity clearinghouse · EDI 837P · received 22 Mar 2026 11:31 · 837P_20260322_476306.edi

Received
22 Mar 2026 11:31
Source
Availity clearinghouse · EDI 837P
File
837P_20260322_476306.edi
Interchange control
594212022
Claim control
CCN-0387126116
Storage
az://centene-audit/claims/2026/03/CLM-0000021.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-20260331-0559
Payment date 31 Mar 2026
Payer Centene
Payee Bayou Oncology Associates
Payee NPI 1427809359
Billed $8,069.76
Allowed $8,069.76
Paid $8,069.76
Patient responsibility $0.00
The remittance shows the full $8,069.76 allowed with no adjustment taken. The audit identified $1,344.96 that should not have been paid.

Line detail

CodeBilled AllowedPaid Should have allowed
J9299 $8,069.76 $8,069.76 $8,069.76 $6,724.80

835 segments

BPR*I*8069.76*C*ACH*CCP*01*061000104*DA*0000*1234567890**01*021000021*DA*9876543210*20260331~
TRN*1*6410320200*1680000000~
DTM*405*20260331~
N1*PR*CENTENE~
N1*PE*BAYOU ONCOLOGY ASSOCIATES*XX*1427809359~
LX*1~
CLP*CLM-0000021*1*8069.76*8069.76**CI*CCN-0387126116*11~