Payment integrity Source document
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Audit queue/ CLM-0000024/ Source document
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Source document

The claim as it was received

Availity clearinghouse · EDI 837P · received 27 Feb 2026 08:31 · 837P_20260227_391599.edi

Received
27 Feb 2026 08:31
Source
Availity clearinghouse · EDI 837P
File
837P_20260227_391599.edi
Interchange control
907061122
Claim control
CCN-8817223789
Storage
az://centene-audit/claims/2026/02/CLM-0000024.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-20260310-1412
Payment date 10 Mar 2026
Payer Centene
Payee Bayou Oncology Associates
Payee NPI 1427809359
Billed $3,083.85
Allowed $3,083.85
Paid $3,083.85
Patient responsibility $0.00
The remittance matches the allowable on file. No variance identified.

Line detail

CodeBilled AllowedPaid Should have allowed
J9355 $3,083.85 $3,083.85 $3,083.85 $3,083.85

835 segments

BPR*I*3083.85*C*ACH*CCP*01*061000104*DA*0000*1234567890**01*021000021*DA*9876543210*20260310~
TRN*1*1774005933*1680000000~
DTM*405*20260310~
N1*PR*CENTENE~
N1*PE*BAYOU ONCOLOGY ASSOCIATES*XX*1427809359~
LX*1~
CLP*CLM-0000024*1*3083.85*3083.85**CI*CCN-8817223789*11~