Billing Version 0.0089897

Charge Audit - Delayed Charges

Visit Count :  78
Patient #56432 Date of Birth Age Primary Insurance Date of Service Provider Location Posted
James Miller (56432) 05/07/1968 48 1096 - United Healthcare (UH) 07/25/2016 Shirley Jones, PT (101) BMS Testing ZZX OFFIX plsA (OFFIC) 08/01/2016
 
CPT Code Units Modifier 1 Modifier 2 Diagnosis Codes POS Indicator Insurance Preauthorization Referring Physician Case Date of Injury
97201 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
97545 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
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Patient #56432 Date of Birth Age Primary Insurance Date of Service Provider Location Posted
Chris Allan (247654) 05/07/1968 48 1096 - United Healthcare (UH) 07/25/2016 Shirley Jones, PT (101) BMS Testing ZZX OFFIX plsA (OFFIC) 08/01/2016
 
CPT Code Units Modifier 1 Modifier 2 Diagnosis Codes POS Indicator Insurance Preauthorization Referring Physician Case Date of Injury
97201 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
97545 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
Add Account Note Edit Charge  

Patient #56432 Date of Birth Age Primary Insurance Date of Service Provider Location Posted
Sam Smith (246477) 05/07/1968 48 1096 - United Healthcare (UH) 07/25/2016 Shirley Jones, PT (101) BMS Testing ZZX OFFIX plsA (OFFIC) 08/01/2016
 
CPT Code Units Modifier 1 Modifier 2 Diagnosis Codes POS Indicator Insurance Preauthorization Referring Physician Case Date of Injury
97201 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
97545 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
Add Account Note Edit Charge  

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