Riverside Family Medicine • Wilmington
Claim Detail
LM
Claim Detail
Review claim readiness, documentation, coding, financial responsibility, and submission blockers.
Tuesday, September 29, 2026
Claim CLM-50841
David Chen
Hypertension follow-up • Sep 29, 2026 • Dr. Ravi Patel
Claim Services
| Code | Description | Units | Charge | Status |
|---|---|---|---|---|
| 99214 | Established patient office visit | 1 | $245.00 | Note needed |
| 36415 | Venipuncture | 1 | $40.00 | Ready |
Diagnosis Information
Primary diagnosisI10 — Essential hypertension
SecondaryR42 — Dizziness
Visit typeFollow-up
Documentation Review
✓
Patient demographics
Complete and validated.
✓
Insurance eligibility
Coverage active on date of service.
Provider note
Claim requires signed documentation supporting 99214.
✓
Diagnosis linkage
Diagnosis codes linked to services.
Claim Activity
Operational history for this claim
Today
3:10 PM
3:10 PM
Billing exception created
Provider note signature missing.
Today
2:58 PM
2:58 PM
Charges generated
Encounter completed and charge review started.
Today
1:45 PM
1:45 PM
Visit began
Hypertension follow-up with Dr. Ravi Patel.
Submission blocked
The provider note is not yet signed. Claim submission should remain blocked until required documentation is complete.
Financial Summary
Expected responsibility by source
Total chargesDate of service
$285.00Expected payerEstimated
$245.00Patient responsibilityCopay
$40.00Related Record
Source visit and patient context