| 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 | 8816 | Mar 3, 2025 | Warner, David W | A0428 | Beebe Hospital |
Beebe Hospital, ED 11, 424 Savannah Road, Lewes, DE 19958
|
Peachtree Health |
Peachtree Health, 26900 Lewes Georgetown Hwy, Harbeson, DE 19951
|
8 | $396.62 | $- | $396.62 |
2025/03/04_(Delaware First Health Medicaid) No individual OON deductible for Delaware First Health Medicaid, MA 03/04/2025
!MCD denial, cannot bill patient
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| 6369 | 8746 | Feb 27, 2025 | Draper, Hertford | A0428 | Beebe Hospital |
Beebe Hospital, ED 24, 424 Savannah Road, Lewes, DE 19958
|
Ocean Grove Post Acute |
Ocean Grove Post Acute, CHK W/ CHARGE, 231 Washington St, Millsboro, DE 19966
|
16.5 | $514.43 | $- | $514.43 |
2025/02/28_(Highmark Health Options Medicaid) No individual OON deductible for 2025, MA 02/28/2025
!MCD denial, unable to bill patient
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| 6369 | 8699 | Feb 25, 2025 | Maull, Willis J | A0428 | Beebe Hospital |
Beebe Hospital, HALL C, 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 |
2025/02/26_(Aetna adv and Delaware First Health Medicaid) No individual OON deductible for 2025, MA 02/26/2025
!MCD does not cover non-emergent
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| 6369 | 7898 | Jan 20, 2025 | Adams, George L | A0130 | Beebe Hospital |
Beebe Hospital, 527, 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 | $95.25 | $- | $95.25 |
!patient uses a walker, not medically necessary
PCS states patient can go by wheelchair van- patient uses walker
(MCR and Mutual of Omaha) Part B deductible left $ 257 for 2025 and No individual OON deductible for 2025, MA 01/21/2025
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| 6369 | 7624 | Jan 7, 2025 | York, Alma L | A0130 | Beebe Hospital |
Beebe Hospital, 4TH FLOOR DISCHARGE LOUNGE, 424 Savannah Road, Lewes, DE 19958
|
32334 ROBIN HOODS LOOP |
32334 ROBIN HOODS LOOP, Millsboro, DE 19966
|
12 | $153.00 | $- | $153.00 |
!billing Beebe, WC transport
2025/05/23 per NR billing Beebe, WC transport. LDZ
Adjusted price per RB email. NR 3/13/25 (using other leg amount)
PCS states patient can use a wheelchair
(Aetna adv and Highmark Health Options Medicaid) No individual OON deductible for 2025, MA 01/08/2025
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| 6369 | 7496 | Dec 31, 2024 | Oakley, Samuel | A0428 | Beebe Hospital |
Beebe Hospital, 360 A, 424 Savannah Road, Lewes, DE 19958
|
32546 SWAMP ROAD |
32546 SWAMP ROAD, Dagsboro, DE 19939
|
23 | $563.17 | $- | $563.17 |
2025/05/13: denied for no PA. -REG
MCD active on DOS 0004140683
Patient is able to sit in wheelchair- has power wheelchair at home LDZ 01/03/2025
Verified BCBS Medicaid(VIRGINIA), address updated as per face sheet but as per Payer address is 'PO BOX 54 NASSAWADOX, VA 23413', MA 01/02/2025
!MCD denial, no PA
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| 6369 | 7358 | Dec 25, 2024 | Conlon, Ellen | A0427 | Beebe Hospital |
Beebe Hospital, ED 1, 424 Savannah Road, Lewes, DE 19958
|
Christiana Hospital |
Christiana Hospital, ED, 4755 Ogletown Stanton Road, Newark, DE 19718
|
82.8 | $1,353.71 | $- | $1,353.71 |
2025/02/26_s/w Nora stated claim rcvd on 12/31/24 and denied on 1/17/2024 as they need Provider Medicaid Management Information System (MMIS) number. As per rep if we don't have the MMIS number , provider need to contact @ 18003439000 to obtained the number. Fax MMIS number on FAX#8772598429. Case Number#48758576 Claim#042781552700.Callref#Nora-2/26/2025. 2/26/2025MK
No insurance information found, No information in face sheet, As per Nsure member have Fidelis Care New York insurance under PT ID # 74140420700 is primary but unable to verify eligbilty,no? Medicaid, MA 12/27/2024
!OOS MCD
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| 6369 | 6240 | Nov 3, 2024 | Theoharis, Themistocles G | A0429 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, SCED 13, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, 227 B, 424 Savannah Road, Lewes, DE 19958
|
23.1 | $731.51 | $140.85 | $590.66 |
!inpatient with Beebe hospital on DOS
2025/05/29: mcr took back full amt, eft 888672148. -REG
2025/04/15_mcr notice of takeback, inpatient status. 4/15/25REG
As checked on waystar, EOB found and claim paid on 11/27/24 and paid $531.14 with pt resp.$135.49 under EFT#888411796 and claim#2924317209690. 11/27/24 MK
Verified MCR and UHC by Nsure, face sheet mising, address updated as per MCR, No hospice, MA 11/11/2024
!Inpatient 11/2-11/5
Submitted.
No PCR. JH 11/04/24
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| 6217 | 10438 | May 19, 2025 | Ritts, Marlene E | A0428 | Beebe Hospital |
Beebe Hospital, ED 1, 424 Savannah Road, Lewes, DE 19958
|
RESIDENCE |
RESIDENCE, 30194 REGATTA BAY BLVD, Lewes, DE 19958
|
0 | $285.74 | $- | $285.74 |
This patient was not on oxygen and was completely ambulatory. You can build this to Beebe at the BLS rate, the nurse refused to downgrade it to wheelchair van.RMB
!Not Medically Neccessary
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| 6217 | 10320 | May 15, 2025 | Sanders, Earl | A0428 | Beebe Hospital |
Beebe Hospital, ED 17, 424 Savannah Road, Lewes, DE 19958
|
28473 DUPONT BLVD |
28473 DUPONT BLVD, Millsboro, DE 19966
|
0 | $285.74 | $- | $285.74 |
No PCS. Request was called in by Christina.Bill Beebe for transport.RMB
2025/05/16: PLEASE ATTACH PCS. HLB
2025/05/15: (UHC Dual adv Plan) No individual OON deductible for 2025, UPS
!No PCS. Request was called in by Christina.Bill Beebe for transport.
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