| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6374 | 8017 | Jan 25, 2025 | Smith, Paul S | A0427 | Beebe Healthcare's South Coastal Emergency Department |
Beebe Healthcare's South Coastal Emergency Department, ED 8, 32750 Roxana Rd, Frankford, DE 19945
|
Beebe Hospital |
Beebe Hospital, 384 A, 424 Savannah Road, Lewes, DE 19958
|
23.1 | $834.90 | $- | $834.90 |
2025/05/29 MCR part A only, GEHA denied claim. LDZ
2025/05/27: denied. secondary eob only shows co45. -REG
2025/5/16_MK -As per IVR claim is still in process.
2025/04/14_As per ivr claim is still in process.Claim#25058314033. 4/14/2025MK
Patient called in with GEHA secondary- filing MCR for denial so GEHA can process as secondary LDZ 02/18/2025
(MCR with Part A only) Part B deductible left $ 0 for 2025 ,MA 01/28/2025
!Insurance Denial, Beebe Payor Last Resort
|
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| 6374 | 7946 | Jan 22, 2025 | Grimes, Lisa K | A0428 | Beebe Hospital |
Beebe Hospital, ED 12, 424 Savannah Road, Lewes, DE 19958
|
Atlantic Shores Rehabilitation And Healthcare Center |
Atlantic Shores Rehabilitation And Healthcare Center, CHK W/ CHARGE, 231 Washington St, Millsboro, DE 19966
|
16.5 | $514.43 | $175.74 | $338.69 |
2025/01/22_(UHC adv and Highmark Health Option Medicaid) No individual OON deductible for 2025, MA 01/22/2025
!Insurance Denial, Beebe Payor Last Resort
|
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| 6374 | 7908 | Jan 20, 2025 | Grimes, Lisa K | A0428 | Beebe Hospital |
Beebe Hospital, 228, 424 Savannah Road, Lewes, DE 19958
|
Atlantic Shores Rehabilitation And Healthcare Center |
Atlantic Shores Rehabilitation And Healthcare Center, CHK W/ CHARGE, 231 Washington St, Millsboro, DE 19966
|
16.5 | $514.43 | $175.74 | $338.69 |
2025/01/22_(UHC adv and Highmark Health Option Medicaid) No individual OON deductible for 2025, MA 01/22/2025
!Insurance Denial, Beebe Payor Last Resort
|
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|
|
| 6374 | 3770 | Jun 26, 2024 | Merchant, John | A0428 | Beebe Hospital |
Beebe Hospital, 421 A, 424 Savannah Road, Lewes, DE 19958
|
Peachtree |
Peachtree, 26890 Lewes-Georgetown Highway, Harberson, DE 19951
|
8 | $387.28 | $59.04 | $328.24 |
2025/4/28: bcbs secondary denied for timely. -REG
Claim submitted on 7/9/24 , s/w Reges-F states No fax on file. As per rep send a corrected claim with correct format with indicator code 16. Callref# I-132482819. 12/19/24MK
Will attached EOB for BCBS LDZ 07/12/2024
OHI? Nr 7/11/24
One crew signature missing LDZ 06/28/2024
!Insurance Denial, Beebe Payor Last Resort
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| 6370 | 10627 | May 27, 2025 | Sternberg, Eddie E | A0428 | Beebe Healthcare's Tunnell Cancer Center |
Beebe Healthcare's Tunnell Cancer Center, 101, 18947 John J Williams Hwy, Rehoboth, DE 19971
|
Beebe Hospital |
Beebe Hospital, 324 A, 424 Savannah Road, Lewes, DE 19958
|
4.1 | $342.57 | $- | $342.57 |
2025/05/28 CANCER TREATMENT and return
|
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|
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| 6370 | 10619 | May 27, 2025 | Bardi, Janis M | A0428 | Beebe Healthcare's Tunnell Cancer Center |
Beebe Healthcare's Tunnell Cancer Center, 101, 18947 John J Williams Hwy, Rehoboth, DE 19971
|
Beebe Hospital |
Beebe Hospital, 327A, 424 Savannah Road, Lewes, DE 19958
|
4.1 | $342.57 | $- | $342.57 |
2025/05/28 CANCER TREATMENT and return
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| 6370 | 10613 | May 27, 2025 | Sternberg, Eddie E | A0428 | Beebe Hospital |
Beebe Hospital, 324 A, 424 Savannah Road, Lewes, DE 19958
|
Beebe Healthcare's Tunnell Cancer Center |
Beebe Healthcare's Tunnell Cancer Center, 101, 18947 John J Williams Hwy, Rehoboth, DE 19971
|
4.2 | $343.96 | $- | $343.96 |
2025/05/28 CANCER TREATMENT and return
|
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| 6370 | 10501 | May 27, 2025 | Bardi, Janis M | A0428 | Beebe Hospital |
Beebe Hospital, 327A, 424 Savannah Road, Lewes, DE 19958
|
Beebe Healthcare's Tunnell Cancer Center |
Beebe Healthcare's Tunnell Cancer Center, 101, 18947 John J Williams Hwy, Rehoboth, DE 19971
|
4.2 | $343.96 | $- | $343.96 |
2025/05/28 CANCER TREATMENT and return
|
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| 6370 | 10542 | May 23, 2025 | Bardi, Janis M | A0428 | Beebe Healthcare's Tunnell Cancer Center |
Beebe Healthcare's Tunnell Cancer Center, 101, 18947 John J Williams Hwy, Rehoboth, DE 19971
|
Beebe Hospital |
Beebe Hospital, 327-A, 424 Savannah Road, Lewes, DE 19958
|
4.1 | $342.57 | $- | $342.57 |
CANCER TREATMENT AND RETURN
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| 6370 | 10500 | May 23, 2025 | Bardi, Janis M | A0428 | Beebe Hospital |
Beebe Hospital, 327-A, 424 Savannah Road, Lewes, DE 19958
|
Beebe Healthcare's Tunnell Cancer Center |
Beebe Healthcare's Tunnell Cancer Center, 101, 18947 John J Williams Hwy, Rehoboth, DE 19971
|
4.2 | $343.96 | $- | $343.96 |
CANCER TREATMENT AND RETURN
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