| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5423 | 7783 | Jan 14, 2025 | Lewi, Kathryn A | A0428 | Beebe Hospital |
Beebe Hospital, ED 12, 424 Savannah Road, Lewes, DE 19958
|
12001 OLD VINE BLVD |
APT 208, 12001 OLD VINE BLVD, Lewes, DE 19958
|
4 | $341.18 | $- | $341.18 |
s/w Nicka stated claim rcvd on 1/18/2025 and still in process as they need Authorization number as provider is OON. TLF# 45-60 days. FAX#8777882764 to send Auth No. Claim#250380122800 Callref#943847948 3/6/2025MK
(Cigna Healthspring adv) No individual OON deductible for 2025, MA 01/16/2025
!No PA
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| 5423 | 7337 | Dec 24, 2024 | Frank, Eileen | A0428 | Beebe Hospital |
Beebe Hospital, ED 37, 424 Savannah Road, Lewes, DE 19958
|
BREAKWATER VILLAGE |
BREAKWATER VILLAGE, 301 Ocean View Blvd, Lewes, DE 19958
|
2 | $306.10 | $- | $306.10 |
One crew signature missing LDZ 01/02/2025
Corrected.
Narrative is incomplete, please review LDZ 12/30/2024
No insurance information found , No information in face sheet , no? Medicaid, checked Nsure but no policy found, MA 12/26/2024
!Uninsured
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| 5422 | 8572 | Feb 20, 2025 | Wietsruk, Jordan | A0429 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, ED 11, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, 529 B, 424 Savannah Road, Lewes, DE 19958
|
23.1 | $687.57 | $- | $749.17 |
2025/04/28 Rejected in Waystar stating unable to locate eligibility for patient. LDZ
Info from Beebe: Insurance = Cigna
ID# 77978156632
No insurance information found, No information in face sheet, no Medicaid, checked Nsure but no policy found, MA 02/21/2025
!Uninsured
|
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| 5133 | 8570 | Feb 19, 2025 | Meade, Patricia A | A0427 | Beebe Hospital |
Beebe Hospital, 368 B, 424 Savannah Road, Lewes, DE 19958
|
Jefferson Hospital For Neuroscience |
Jefferson Hospital For Neuroscience, 7 N 720 B, 900 Walnut St, Philadelphia, PA 19107
|
137 | $1,887.33 | $- | $1,887.33 |
2025/05/06: Review with RG, confirm DOS is 2/19/2025 and Beebe is responsible. NR
Inpatient with Beebe 02/12 - 02/20 per PGBA LDZ 03/17/2025
mcr denied for inpatient. 3/11/25REG
!Inpatient
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| 5035 | 6795 | Nov 29, 2024 | Brenan, Kelly | A0427 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, ED 10, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, 412 A, 424 Savannah Road, Lewes, DE 19958
|
23.1 | $815.22 | $- | $815.22 |
Beebe provided - DE Medicaid
ID# 0000966236 - JM 3/19/25
No insurance information found , Face sheet missing , Medicaid found inactive under PT id #0000966236, checked Nsure but no policy found, MA 12/03/2024
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| 5035 | 6758 | Nov 27, 2024 | Cavanaugh, Daniel | A0428 | Beebe Hospital |
Beebe Hospital, 301 A, 424 Savannah Road, Lewes, DE 19958
|
38537 BLUE HEN DRIVE |
38537 BLUE HEN DRIVE, Selbyville, DE 19975
|
31 | $635.33 | $67.93 | $567.40 |
2024/12/02_Verified UHC, no secondary or Medicaid, address verified, MA 12/02/2024
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| 5035 | 6741 | Nov 26, 2024 | Smith, Richard | A0429 | Beebe Hospital |
Beebe Hospital, ED 16, 424 Savannah Road, Lewes, DE 19958
|
Christiana Hospital |
Christiana Hospital, ED, 4755 Ogletown Stanton Road, Newark, DE 19718
|
82.3 | $1,265.49 | $- | $1,265.49 |
2025/5/22_MK- Called Sussez Correctional s/w Michal stated the claim representative will only assist through E-MAIL. As per rep we can Email on Nmonk@Vitalcorehs.com for claims with Patient Name , DOB , Date of Service and Place of service.Callref# Mishal-5/22/2025
Beebe provided - Vitalcore
ID# 222747261 - JM 3/19/25
No insurance information found , no insurance information in face sheet, Medicaid found inactive under PT ID #0000384079, checked Nsure but no policy found, address updated as per face sheet, MA 12/02/2024
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| 5035 | 6607 | Nov 21, 2024 | Lewis, Christine | A0428 | Beebe Hospital |
Beebe Hospital, ED 35, 424 Savannah Road, Lewes, DE 19958
|
Genesis Healthcare - Milford Center |
Genesis Healthcare - Milford Center, 700 Marvel Road, Milford, DE 19963
|
22.5 | $558.66 | $502.85 | $55.81 |
Beebe provided - Medicare / Amerihealth Caritas
ID# 2D24TW0KF94 / 0003353506 - JM 3/19/25
No insurance information found , No information in face sheet , no? Medicaid, checked Nsure but no policy found, MA 11/22/2024
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| 5035 | 6492 | Nov 16, 2024 | Cavanaugh, Daniel | A0428 | Beebe Hospital |
Beebe Hospital, 303, 424 Savannah Road, Lewes, DE 19958
|
38537 BLUE HEN DR |
38537 BLUE HEN DR, Selbyville, DE 19975
|
30 | $626.31 | $67.93 | $558.38 |
2024/11/19_Verified UHC, no secondary or Medicaid, address updated as per face sheet, MA 11/19/2024
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| 5035 | 6488 | Nov 16, 2024 | Myers, Olivia | A0429 | Beebe Hospital |
Beebe Hospital, ED 9, 424 Savannah Road, Lewes, DE 19958
|
Nemours/A.I. duPont Hospital for Children |
Nemours/A.I. duPont Hospital for Children, ED, 1600 Rockland Road, Wilmington, DE 19803-3616
|
91.9 | $1,352.08 | $- | $1,352.08 |
2025/5/6_MK - Call AIS root INS. s/w Jennifer Albert z stated they rcvd claim on 3/21/2025 and still pending as she waiting for Update W9 form form provider. As per rep send the W9 form with Claim number that is G2WWK3DE on Fax# 6143621751.
Beebe provided - AIS Root Insurance Company
ID# G2WWK3DE - JM 3/19/25
One crew and patient signature missing LDZ 11/25/2024
No insurance information found , Face sheet missing , no? Medicaid, checked Nsure but no policy found, MA 11/25/2024
Submitted.
No PCR. JH 11/17/24
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