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    Claim Type Claim Number Patient Service Date

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    Abhishek Banerjee
    This document contains a list of 7 medical claims for patient Ajay between 2018 and 2024. It includes details of the claim type, number, service date, amount billed and allowed, deductible, coinsurance, copay, not covered amount, patient cost and status of each claim. The claims were submitted to providers in New Jersey and had a mix of approved, denied and paid statuses.

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    Claim Type Claim Number Patient Service Date

    Uploaded by

    Abhishek Banerjee
    17 views3 pages
    This document contains a list of 7 medical claims for patient Ajay between 2018 and 2024. It includes details of the claim type, number, service date, amount billed and allowed, deductible, coinsurance, copay, not covered amount, patient cost and status of each claim. The claims were submitted to providers in New Jersey and had a mix of approved, denied and paid statuses.

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    claims

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    Claims - Copy

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    This document contains a list of 7 medical claims for patient Ajay between 2018 and 2024. It includes details of the claim type, number, service date, amount billed and allowed, deductible, coinsurance, copay, not covered amount, patient cost and status of each claim. The claims were submitted to providers in New Jersey and had a mix of approved, denied and paid statuses.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    17 views3 pages

    Claim Type Claim Number Patient Service Date

    Uploaded by

    Abhishek Banerjee
    This document contains a list of 7 medical claims for patient Ajay between 2018 and 2024. It includes details of the claim type, number, service date, amount billed and allowed, deductible, coinsurance, copay, not covered amount, patient cost and status of each claim. The claims were submitted to providers in New Jersey and had a mix of approved, denied and paid statuses.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 3

    Claim Type Claim Number Patient Service Date

    Medical 26183 Ajay 21/09/2019


    Medical 5484538 Ajay 21/09/2020
    Medical 26183 Ajay 21/09/2021
    Medical 5484538 Ajay 21/09/2022
    Medical 26183 Ajay 21/09/2023
    Medical 5484538 Ajay 21/09/2024
    Medical 26183 Ajay Nov. 07, 2018
    Provided By Billed Allowed Amount Paid Deductible Coinsurance
    NJ Office $756.00 0 0 $23.34 $0.00
    NJ Office $1018.00 0 0 0 0
    NJ Office $326.00 0 0 0 0
    NJ Office $326.00 0 0 0 0
    NJ Office $98.00 0 0 0 0
    NJ Office $206.00 0 0 0 0
    NJ Office $223.00 0 0 0 0
    CopayNot Covered Your Cost Status
    $0.00 $0.00 $23.34 Approved
    0 0 $1018.00 Denied
    0 0 $0.00 Approved
    0 0 $326.00 Denied
    0 0 $98.00 Denied
    0 0 $206.00 Denied
    0 0 $0.00 Approved

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