Total Records: 192
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Array ( [id] => 770 [invoice_id] => 4696 [dispatch_id] => 1296 [date_time_of_service] => 2023-11-28 23:13:00 [patient_full_name] => Cahoe, Charles [billable_service_code] => A0427 [origin_name] => Beebe Hospital [origin_address] => Beebe Hospital, 377 B, 424 Savannah Road, Lewes, DE 19958 [destination_name] => Thomas Jefferson University Hospital [destination_address] => Thomas Jefferson University Hospital, 5226 GIBBON BUILDING, 111 S. 11th St, Philadelphia, PA 19107 [mileage] => 119.8 [price_invoiced] => $1,651.25 [amount_received] => $73.07 [current_amount_due] => $1,578.18 [billing_notes] => 2024/12/27_Humana take back for in facility global fee. NR 12/27/24 Claim denied The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. No inpatient info founf on PGBA. LDZ 03/08/2024 Denied for mileage. NR 1/30/24 Facesheet attached is for a different patient, please attach correct facesheet for insurance LDZ 11/29/2023 Facesheet attached - WJO !Primary payer take back due to global fee [beebe_comments] => [aec_comments] => [epic_comments] => ) Array ( [id] => 769 [invoice_id] => 4696 [dispatch_id] => 359 [date_time_of_service] => 2023-08-13 03:32:00 [patient_full_name] => Bonner, Carmen [billable_service_code] => A0427 [origin_name] => Beebe Hospital [origin_address] => Beebe Hospital, ED 14, 424 Savannah Road, Lewes, DE 19958 [destination_name] => Children's Hospital of Philadelphia [destination_address] => Children's Hospital of Philadelphia, 3E RM 26, 34th Street And Civic Center Blvd, Philadelphia, PA 19104 [mileage] => 115 [price_invoiced] => $1,609.01 [amount_received] => $73.07 [current_amount_due] => $1,535.94 [billing_notes] => 2024/12/16_Claim submitted on 9/11/24 , s/w Kathy stated that the Home plan upheld the appeal and for more information , you can message to payer on portal or on Availity (by clicking on Message this payer) . Claim# 22729075994. Callref# Kathy 12/16/24. 12/16/24/MK #359- 08/20/2023 MB !Primary insurance not covered [beebe_comments] => [aec_comments] => [epic_comments] => )
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
4696 1296 Nov 28, 2023 Cahoe, Charles A0427 Beebe Hospital
Beebe Hospital, 377 B, 424 Savannah Road, Lewes, DE 19958
Thomas Jefferson University Hospital
Thomas Jefferson University Hospital, 5226 GIBBON BUILDING, 111 S. 11th St, Philadelphia, PA 19107
119.8 $1,651.25 $73.07 $1,578.18
2024/12/27_Humana take back for in facility global fee. NR 12/27/24 Claim denied The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. No inpatient info founf on PGBA. LDZ 03/08/2024 Denied for mileage. NR 1/30/24 Facesheet attached is for a different patient, please attach correct facesheet for insurance LDZ 11/29/2023 Facesheet attached - WJO !Primary payer take back due to global fee
4696 359 Aug 13, 2023 Bonner, Carmen A0427 Beebe Hospital
Beebe Hospital, ED 14, 424 Savannah Road, Lewes, DE 19958
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia, 3E RM 26, 34th Street And Civic Center Blvd, Philadelphia, PA 19104
115 $1,609.01 $73.07 $1,535.94
2024/12/16_Claim submitted on 9/11/24 , s/w Kathy stated that the Home plan upheld the appeal and for more information , you can message to payer on portal or on Availity (by clicking on Message this payer) . Claim# 22729075994. Callref# Kathy 12/16/24. 12/16/24/MK #359- 08/20/2023 MB !Primary insurance not covered
Showing 191 to 192 of 192 records