Medmonk EOB Intake Portal

Pending Cases

4

Awaiting review

In Review

2

Currently being processed

Completed Today

7

Avg. 11 min each

Needs Further Review

1

Flagged for follow-up

📋 Cases In Review

Case ID	Patient	Payer	Plan Type	Assigned To	Status	Action
C-2026-0084	Margaret T. Collins	UnitedHealthcare	Medicare Adv.	Jane Doe	In Review
C-2026-0085	Robert J. Hernandez	Aetna Better Health	Managed Medicaid	Alex Rivera	Needs Review

📥 Recent Pending Cases

Case ID	Patient	Payer	Documents	Received	Action
C-2026-0088	Susan M. Park	Humana	EOB, HCFA, Ins. Card	Today 9:14 AM

📥 Pending Cases

Case ID	Patient Name	DOB	Payer	Plan Type	Documents	Received
C-2026-0088	Susan M. Park	03/15/1952	Humana	Medicare Adv.	EOB, HCFA, Ins. Card	Today 9:14 AM
C-2026-0089	David L. Foster	07/22/1948	Wellcare	Medicare	EOB, ERA	Today 8:47 AM
C-2026-0090	Latoya B. Williams	11/05/1985	Aetna Better Health (IL)	Managed Medicaid	EOB, HCFA, ERA, Ins. Card	Today 7:58 AM
C-2026-0091	James A. Nguyen	05/30/1979	BCBS Illinois	Commercial	EOB, HCFA	Yesterday 4:42 PM

🔍 Cases In Review

Case ID	Patient	Payer	Plan Type	Reviewer	Started	Status	Action
C-2026-0084	Margaret T. Collins	UnitedHealthcare	Medicare Adv.	Jane Doe	Today 10:02 AM	In Review
C-2026-0085	Robert J. Hernandez	Aetna Better Health	Managed Medicaid	Alex Rivera	Today 9:35 AM	Needs Further Review

✅ Completed Cases

Case ID	Patient	Payer	Plan Type	Reviewer	Completed	Duration
C-2026-0083	Patricia L. Moore	Cigna Healthcare	Medicare Adv.	Jane Doe	Today 9:58 AM	9 min
C-2026-0082	Anthony R. Jackson	Wellcare (WellCare by Allwell)	Medicare	Alex Rivera	Today 9:31 AM	14 min
C-2026-0081	Maria E. Gonzalez	CountyCare (IL)	Managed Medicaid	Jane Doe	Today 8:55 AM	11 min
C-2026-0080	Thomas H. Bradley	BCBS Illinois	Commercial	Sam Lee	Yesterday 4:50 PM	8 min

🏥 Payers & Plan Reference Sourced from Medicare Part D BIN/PCN data & internal training

Payer	Plan Type	BIN	PCN Identifier	ID Pattern	Notes

👤 Employee Performance

Employee	Completed	Avg. Time	Flagged
Jane Doe	42	10 min	3
Alex Rivera	38	12 min	5
Sam Lee	29	9 min	2
Maria Chen	51	8 min	1

📅 Activity Timestamps

Case ID	Reviewer	Started	Completed	Status
C-2026-0083	Jane Doe	9:49 AM	9:58 AM	Done
C-2026-0085	Alex Rivera	9:35 AM	—	Flagged
C-2026-0084	Jane Doe	10:02 AM	—	Active

🏥 Volume by Payer

Payer	Cases	% of Total
UnitedHealthcare	48	29%
Humana	35	21%
Aetna	30	18%
BCBS	27	16%
Wellcare	22	13%
Other	5	3%

📊 Plan Type Breakdown

Plan Type	Cases	Avg. Time
Medicare Advantage	74	10 min
Medicare (Original)	38	12 min
Managed Medicaid	29	11 min
Commercial	21	8 min
Tricare / VA	5	14 min

📄 EOB

📋 HCFA 1500

💾 ERA 835

🪪 Ins. Card

📄

EOB Document

Uploaded by provider — click fields in extracted panel to highlight source location

EXPLANATION OF BENEFITS

                    Payer: UnitedHealthcare (Medicare Advantage)

                    Contract ID: H0169 | BIN: 610097 | PCN: 9999

                    Member ID: 1AB2CD3EF45

                    Member: MARGARET T COLLINS

                    DOB: 03/12/1947 | Age: 78

                    Group #: 80652 | Seq: 253

                    Provider: NORTHSHORE SPECIALTY PHARMACY

                    NPI: 1234567890

                    Date of Service: 03/10/2026

                    Rx #: 7845213 | NDC: 00093-5325-01

                    Drug: Eliquis 5mg #60

                    Billed: $1,240.00

                    Allowed: $1,214.80

                    Sequestration (Adj 253): -$24.30

                    Plan Paid: $890.50

                    Member Copay: $300.00

                    Member Responsibility: $300.00

                    ⚠ Adjustment Code 253 present — Medicare/Medicare Advantage

🤖 AI Observations

🔵

Medicare/Medicare Advantage Patient — Age 78, Member ID pattern 1AB2CD3EF45 confirms Medicare Advantage. Sequestration Adj. Code 253 present on EOB. RxPCN: 9999 matches UHC Medicare Part D (BIN 610097). M3P/MPPP BIN confirmed.

⚠️

Sequestration Applied: $24.30 reduction (Adj 253) per Medicare Advantage rules — confirm plan paid amount reflects 2% sequestration reduction from $914.80 → $890.50.

💡

UHC Contract ID H0169 found in Part D reference. PCN 9999, BIN 610097 — consistent with M3P MPPP enrollment. Verify M3P payment spread if applicable.

🤖

AI-Assisted Intake — Case C-2026-0084

Review extracted fields, confirm accuracy, then submit. Highlighted fields need attention.

⚕ Medicare Advantage Overall: 94% Conf.

📑 AI Extracted Data From EOB + HCFA + ERA + Card

Patient Information

Patient Name 99%

Margaret T. Collins

Date of Birth 99%

03/12/1947

Age 99%

78 yrs — ⚠️ Medicare-eligible age

Address 97%

847 N. Elm St, Palatine IL 60074

Insurance / Payer

Payer 99%

UnitedHealthcare

Plan Type 99%

Medicare Advantage (Part C)

Contract ID 98%

H0169

Member ID 98%

1AB2CD3EF45

Group Number 96%

80652

RxBIN / PCN 99%

610097 / 9999

Claim / Service

Date of Service 99%

03/10/2026

Provider NPI 98%

1234567890

Rx Number 99%

7845213

NDC 97%

00093-5325-01

Drug / Service 98%

Eliquis 5mg #60

Diagnosis Code 96%

Z79.01

Financial

Billed Amount 99%

$1,240.00

Allowed Amount 98%

$1,214.80

Sequestration (Adj 253) 97%

-$24.30 ⚠️ Confirm matches 2% calc

Plan Paid 88%

$890.50 ⚠️ Verify after sequestration

Member Copay / Responsibility 97%

$300.00

Adjustment Codes 98%

CO-253, PR-3, CO-45

📝 Intake Form Auto-filled — review & confirm

Patient Information

Patient Name

Date of Birth

Address

Insurance / Payer

Payer

Plan Type

Contract ID

Member ID

Group Number

RxBIN / PCN

Claim / Service

Date of Service

Provider / NPI

Rx Number

NDC

Drug / Service Description

Diagnosis Code(s)

Financial

Billed Amount

Allowed Amount

Sequestration Adj. (253)

Plan Paid

Member Copay / Responsibility

Adjustment Codes

Reviewer Notes