| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6369 | 9851 | Apr 22, 2025 | Maharaj, Gyanwattie | A0428 | Beebe Hospital |
Beebe Hospital, ED 12, 424 Savannah Road, Lewes, DE 19958
|
Excelcare at Lewes |
Excelcare at Lewes, Chk w/ FD, 301 Ocean View Blvd, Lewes, DE 19958
|
1 | $299.60 | $9.60 | $290.00 |
2025/04/30: (UHC Dual Plan) No individual OON deductible for 2025, UPS
Submitted.
!MCD does not cover non-emergent
|
|
|
|
| 6369 | 9816 | Apr 20, 2025 | Moore, James L | A0428 | Beebe Hospital |
Beebe Hospital, 537 A, 424 Savannah Road, Lewes, DE 19958
|
PAM Health - Rehabilitation Hospital of Georgetown |
PAM Health - Rehabilitation Hospital of Georgetown, 22303 Dupont Blvd, Georgetown, DE 19947
|
16.1 | $508.89 | $- | $508.89 |
!MCR part A only, doesn't cover ambulance transports
MCR with Part A only
|
|
|
|
| 6369 | 9750 | Apr 17, 2025 | Willey, Bonnie J | A0428 | Beebe Hospital |
Beebe Hospital, 375 B, 424 Savannah Road, Lewes, DE 19958
|
Harbor Healthcare & Rehabilitation Center |
Harbor Healthcare & Rehabilitation Center, Chk w/ FD, 301 Ocean View Blvd, Lewis, DE 19958
|
1 | $299.60 | $49.27 | $250.33 |
(Aetna adv and Amerihealth Caritas Medicaid) No individual OON deductible for 2025, UPS 04/18/2025
!MCD does not cover non-emergent
|
|
|
|
| 6369 | 9722 | Apr 15, 2025 | Green, Richard A | A0428 | Beebe Hospital |
Beebe Hospital, ED HALL B, 424 Savannah Road, Lewes, DE 19958
|
Peachtree Health |
Peachtree Health, 26900 Lewes Georgetown Hwy, Harbeson, DE 19951
|
8 | $396.62 | $- | $396.62 |
!MCD does not cover non-emergent
|
|
|
|
| 6369 | 9671 | Apr 13, 2025 | Maull, Willis J | A0428 | Beebe Hospital |
Beebe Hospital, ED 6, 424 Savannah Road, Lewes, DE 19958
|
Excelcare at Lewes |
Excelcare at Lewes, Chk w/ FD, 301 Ocean View Blvd, Lewes, DE 19958
|
1 | $299.60 | $64.60 | $235.00 |
!MCD does not cover non-emergent
|
|
|
|
| 6369 | 9597 | Apr 8, 2025 | Kravis, Robert J | A0428 | Beebe Hospital |
Beebe Hospital, WAITING ROOM, 424 Savannah Road, Lewes, DE 19958
|
34122 PINEWOOD CIRCLE |
34122 PINEWOOD CIRCLE, Lewes, DE 19958
|
3 | $327.32 | $- | $327.32 |
! no PCS received from Beebe, not billable
2025/05/21 no PCS received from Beebe, not billable to insurance. Billing Beebe LDZ
2025/04/23_Facesheet attached. No Faxed PCS submitted by Beebe ED.RMB
Needs PCS
(MCR and Amerihealth Caritas Medicaid) Part B deductible left $ 0 for 2025 and No individual OON deductible for Amerihealth Caritas Medicaid, UPS 04/23/2025
Emailed Rich for PCS. LDZ 04/23/2025
Submitted.
PCS not attached, please attach LDZ 04/09/2025
Submitted.
PCS is not attached LDZ 04/09/2025
|
|
|
|
| 6369 | 9586 | Apr 8, 2025 | Maull, Willis J | A0428 | Beebe Hospital |
Beebe Hospital, ED 3, 424 Savannah Road, Lewes, DE 19958
|
Harbor Healthcare & Rehabilitation Center |
Harbor Healthcare & Rehabilitation Center, Chk w/ FD, 301 Ocean View Blvd, Lewis, DE 19958
|
1 | $299.60 | $64.60 | $235.00 |
(Aetna adv and Delaware First Health Medicaid) No individual OON deductible for 2025, MA 04/08/2025
!MCD does not cover non-emergent
|
|
|
|
| 6369 | 9358 | Mar 27, 2025 | Davis, Gerald T | A0428 | Beebe Hospital |
Beebe Hospital, ED HALL B, 424 Savannah Road, Lewes, DE 19958
|
Taton House |
Taton House, 18090 Harbeson Road, Milton, DE 19968
|
9.8 | $421.57 | $- | $421.57 |
2025/03/28_Submitted.
No PCR. JH 03/28/25
!MCD denial, unable to bill patient
|
|
|
|
| 6369 | 9321 | Mar 26, 2025 | Davis, Gerald T | A0428 | Beebe Hospital |
Beebe Hospital, 422 DISCHARGE LOUNGE, 424 Savannah Road, Lewes, DE 19958
|
Meadow Wood Behavioral Health |
Meadow Wood Behavioral Health, 575 S. Dupont Hwy, New Castle, DE 19720
|
77.9 | $1,084.08 | $- | $1,084.08 |
2025/03/27_PCS not attached
(Highmark Health Options Medicaid) No individual OON deductible for 2025, MA 03/27/2025
!MCD denial, unable to bill patient
|
|
|
|
| 6369 | 8975 | Mar 11, 2025 | Farmer, Louise W | A0428 | Beebe Hospital |
Beebe Hospital, 511 A, 424 Savannah Road, Lewes, DE 19958
|
Harrison House Of Georgetown |
Harrison House Of Georgetown, 110 W North St, Georgetown, DE 19947
|
15.5 | $500.57 | $185.57 | $315.00 |
2025/03/12_One crew and transfer of care signature missing
(Humana adv and Medicaid) No individual OON deductible for 2025,?MA 03/12/2025
!MCD does not cover non-emergent
|
|
|
|

