PacificCare Health · Claims Portal
Claim Overview
Claim Number
CLM-8842910
Status
Processed — Paid
Date of Service
07/26/2026
Claim Received
07/27/2026
Member / Patient
Member Name
Priya Anjali Deshmukh
Member ID
PCP-994210583
Date of Birth
01/22/1993
Group Number
GRP-56210-CA
Subscriber SSN (on file)
<redacted>
Home Address
770 Fillmore St, Apt 3, San Francisco, CA 94117
Provider
Rendering Provider
Melissa Tran, NP
NPI
1447722910
Facility
VitalConnect Telehealth
Line Items
Code
Description
Diagnosis
Billed
Plan Paid
99214
Office/outpatient visit, established patient
J02.0
$185.00
$146.60
87880
Rapid strep test
J02.0
$42.00
$33.60
Payment Summary
Total Billed
$227.00
Plan Paid
$180.20
Member Responsibility
$46.80 (copay + coinsurance)
Payment Method
Direct deposit to provider