1
Open the claim in EasyCap
Use Microsoft Edge. Work on the screen. Do not edit the database.
WanPanel Portal · EasyCap
Indigo is the path you operate. A side card is a split: stop, hand back, or leave for a later contract. The Agent demo replays that path on this claim.
Use Microsoft Edge. Work on the screen. Do not edit the database.
Yes — hospital 837I / UB-04. Continue down.
All three — ER facility claim. Continue down.
Yes — member is at another AHMC hospital, not their assigned one. Only this contract stays on the line.
Absent — straightforward. Base price is 100% Medi-Cal fee schedule.
Utilities → Apply adjustments → PDCR. Paid at the contract rate. No per diem on this claim.
Exclusion first: revenue code, then 21% or GMP. Then how the claim was paid. Round to two decimals.
Matches — release the claim.
Paid regular claims → commercial / senior medical. First submission: mark first sub and enter the UDF number.
| Rev | Seq | From | Procedure | Billed | Contract | Net pay | Adj | Resp |
|---|---|---|---|---|---|---|---|---|
| 0250 | 1 | 10/24/2026 | P-Z710 | 69.99 | 0.00 | 0.00 | — | HSMSO |
| 0250 | 2 | 10/24/2026 | P-Z710 | 47.83 | 0.00 | 0.00 | — | HSMSO |
| 0450 | 3 | 10/24/2026 | P-Z7502 | 566.60 | 34.58 | 34.58 | — | HSMSO |
| Implants | |
| Non-implantable supplies · rev 274, 275, 276, 278 | |
| Rev 279 · item charge under $2,500 | 21% |
| Rental equipment · rev 290, 291 | 21% |
| Pharmaceuticals · rev 0636 · Alhambra, day cost over $250. Else GMP. | 21% / GMP |
| CT · per scan | $355 |
| MRI · per scan | $445 |
| Blood · rev 380, 381, 382, 390 | 100% |