| Invoice ID | Dispatch ID | Service Date | Patient Name | Service Code | Origin Name | Origin Address | Destination Name | Destination Address | Mileage | Price Invoiced | Amount Received | Amount Due | Billing Notes | Beebe Comments | AEC Comments | Epic Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3818 | 1973 | Jan 27, 2024 | Twigg, Zachary | A0428 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, ED 5, 32750 Roxana Rd, Frankford, DE 19945
|
Nemours/A.I. duPont Hospital for Children |
Nemours/A.I. duPont Hospital for Children, ER, 1600 Rockland Road, Wilmington, DE 19803-3616
|
108.3 | $1,254.22 | $- | $1,254.22 |
No Date
!MCD denial, non-emergent transport
|
|
|
|
| 4805 | 5068 | Aug 30, 2024 | Perez Hernandez, Briseyda | A0427 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, ED 14, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, ED, 424 Savannah Road, Lewes, DE 19958
|
23 | $766.72 | $- | $3,444.00 |
Beebe provided DE Medicaid ID# 0003808737. Nr 3/18/25
No insurance information found , No information in face sheet , no? Medicaid, checked Nsure but no policy found, MA 09/03/2024
!Uninsured
|
|
|
|
| 4805 | 4539 | Aug 3, 2024 | Bolden, Daniel | A0429 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, ED 13, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, 529 B, 424 Savannah Road, Lewes, DE 19958
|
23 | $686.72 | $- | $2,754.00 |
2025/07/07 elig shows pts first name as 'daniel,' moving back to review queue. -REG
2025/07/07: bcbs needs more info, updated appeals board. -REG
2025/05/29: Mailed appeal to Highmark BCBS. SM
2025/05/27 per Availity claim # 22156099704 denied for Our records indicate the patient does not have coverage for the service dates. Therefore, no payment can be made, not for patients demographics. LDZ
2025/05/25: Recheck eligibility based on DOB note. NR
2025/5/6_MK - As checked on Availity claim#22156099704 denied on 3/29/2025 as Remark Code: S0205 We are unable to identify this patient from the information submitted. Further check in documents patient DOB is 5/13/1961. so we need to send corrected claim with correct DOB.
Beebe provided Highmark BCBS # R59593728. NR 3/18/25
Unable to locate any insurance and FS insurance is blank. LDZ 08/06/2024
!Uninsured
|
|
|
|
| 4805 | 3016 | May 8, 2024 | Espinoza-Elzira, Jesus | A0429 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, 12, 32750 Roxana Rd, Frankford, DE 19945
|
Nemours/A.I. duPont Hospital for Children |
Nemours/A.I. duPont Hospital for Children, ED, 1600 Rockland Road, Wilmington, DE 19803-3616
|
108.3 | $1,409.22 | $- | $4,460.00 |
MCD is active, please file. member ID # 0002885456 NR. NR 3/18/25
MCD inactive on DOS LDZ 05/13/2024
!Uninsured
|
|
|
|
| 4805 | 2598 | Mar 28, 2024 | Vasquez Martinez, Joselyn U | A0429 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, 10, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, ER, 424 Savannah Road, Lewes, DE 19958
|
23 | $686.72 | $- | $2,754.00 |
NON-CITIZEN EMERGENCY, LABOR, AND DELIVERY, ambulance is covered. Corrected name spelling. NR 3/18/25
Per Nsure no insurance or patient info found LDZ 04/01/2024
!Uninsured
|
|
|
|
| 4805 | 5613 | Sep 30, 2024 | Shultz, Anthony | A0429 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, 14, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, 381A, 424 Savannah Road, Lewes, DE 19958
|
23 | $686.72 | $- | $686.72 |
2024/10/02_Verified BCBS (Georgia) by Nsure, Face sheet missing, address updated as per bcbs, No secondary or Medicaid, MA 10/02/2024
!Patient Invoiced. No response.
|
|
|
|
| 4805 | 5254 | Sep 10, 2024 | Jones, John | A0429 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, ED 7, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, 372 B, 424 Savannah Road, Lewes, DE 19958
|
23 | $686.72 | $- | $2,754.00 |
2025/05/23: Emailed follow up to RM on denial.NR
2025/04/29 bcbs deneid again for unable to identify pt. REG
Added # to ID, refiling. NR 4/15/25
Sent denial to Rebecca. NR 4/14/25
Beebe provided Highmark BCBS ID# D9V3HZN3037. Nr 3/18/25
As per face sheet we have PIP Personal Injury plan under PT ID # 592624GP is primary but unable to get verify eligibilty, no secondary or Medicaid found inactive under PT ID #0002113913, Address updated as per face sheet, MA 09/16/2024
!Uninsured
|
|
|
|
| 4805 | 5199 | Sep 6, 2024 | Velasquez, Juan | A0427 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, 1, 32750 Roxana Rd, Frankford, DE 19945
|
Nemours/A.I. duPont Hospital for Children |
Nemours/A.I. duPont Hospital for Children, ED, 1600 Rockland Road, Wilmington, DE 19803-3616
|
108.3 | $1,489.22 | $- | $1,489.22 |
2024/09/10_2 crew signature missing on PCR LDZ 09/10/2024
No insurance information found , Face sheet missing , no? Medicaid, checked Nsure but no policy found, MA 09/09/2024
!Uninsured
|
|
|
|
| 4805 | 5041 | Aug 29, 2024 | Bedell, Zachary | A0427 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, 8, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, ED, 424 Savannah Road, Lewes, DE 19958
|
23 | $766.72 | $- | $766.72 |
2024/08/30_Tricare ineligible LDZ 08/30/2024
!Uninsured
|
|
|
|
| 4805 | 4809 | Aug 17, 2024 | Barnes, Heather | A0429 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, 7, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, 320B, 424 Savannah Road, Lewes, DE 19958
|
23 | $686.72 | $- | $686.72 |
2025/03/18_Beebe provided Aetna ID# 1020001560. Nr 3/18/25
!Patient Invoiced 3x
|
|
|
|

