Claims

CLM-2026-0005

Denied

Sharing Need · Mar 25, 2026 · Metro Urgent Care

Billed

$1,200.00

Allowed

$950.00

Approved

$0.00

Member Resp.

$1,200.00

Claim Details
Provider
Metro Urgent Care
Service Date
Mar 25, 2026
Submitted
Mar 26, 2026
Auto-Adjudicated
No
Denial Reason
Service not eligible under tobacco attestation failure
Member

James Rivera

MBR-10004

Active
Diagnosis Codes
M75.10Rotator cuff syndrome, unspecified shoulder(Principal)
Service Lines
#CPTDescriptionBilledAllowedApprovedMember Resp.
199215Office visit, established patient (level 5)$350.00$225.00$0.00$350.00
273030Shoulder X-ray, 2+ views$180.00$48.00$0.00$180.00
Adjudication Trace
Fee schedule lookup
Eligibility check
Tobacco surcharge applied
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