Adjust: Patientname Carriername Ptothercarrierssn/Claim# Doi Dos Tos

Adjust
PatientName CarrierName PTOtherCarrierSSN/Claim# DOI DOS TOS
MILLER. ZACK ZURICH N/A 2840323628 8/25/2021 8/25/2021 WC
GOMEZ. JUAN ZURICH MEDRISK 2840338970001 10/20/2022 11/11/2022 WC
DOUGLAS. STEVEN ZURICH MEDRISK 2840338644 10/13/2022 10/13/2022 WC
HO. BA ZURICH ALIGN NETWOR 2840339326 9/29/2022 11/2/2022 WC
OMAR. WASSAN ZURICH N/A xxx-xx-9999 2/16/2021 10/30/2022 WC
MILLER. ZACK ZURICH N/A 2840323628 8/25/2021 8/25/2021 WC

Appeal upheld
NGUYEN. QUAT ZURICH N/A 2840329966 2/17/2022 3/7/2022 WC
NGUYEN. QUAT ZURICH N/A 2840329966 2/17/2022 3/14/2022 WC

ESTRADA. JAVIER TRAVELERS N/A 2230539899 4/25/2022 4/27/2022 WC
ESTRADA. JAVIER TRAVELERS N/A 2230539899 4/25/2022 5/2/2022 WC
CORREA CHAVEZ. TO ZURICH N/A 2230520215 11/16/2021 11/16/2021 WC
HIDALGO. LANIER ZURICH N/A 2230566070 10/28/2022 11/7/2022 WC
DUDLEY. JAMES ZURICH N/A 2840336321 8/10/2022 9/1/2022 WC
JANO. FAYAD ZURICH ALIGN NETWOR 2230563763 10/4/2022 10/18/2022 WC
MUSE. ASHA ZURICH MEDRISK 2230564520 10/16/2022 10/19/2022 WC
MUSE. ASHA ZURICH N/A 2230564520 10/16/2022 10/21/2022 WC

SPANN. JEREMY ZURICH N/A 2840308588 7/20/2020 7/20/2020 WC
JACKSON. JOHN ZURICH MEDRISK 2840333576 6/1/2022 6/1/2022 WC
BARNES. BENJAMIN ZURICH AMERICAN/A 2840335390 7/14/2022 7/20/2022 WC

Claim paid
LESINI. TERESA ZURICH N/A 2230557787 8/31/2022 9/6/2022 WC
LESINI. TERESA ZURICH N/A 2230557787 8/31/2022 9/21/2022 WC
BEASLEY. COURTNEY ZURICH ALIGN NETWOR 2840339822 11/9/2022 11/12/2022 WC
DURAN LOPEZ. ALEJ ZURICH N/A WC 2230552732 7/28/2022 7/28/2022 WC

GALICIA GOMEZ. MARZURICH N/A 2840325193 7/1/2021 10/13/2021 WC
GALICIA GOMEZ. MARZURICH N/A 2840325193 10/13/2021 10/22/2021 WC
MARTINEZ. LORENZOZURICH N/A 2230556091 8/18/2022 9/26/2022 WC
PEREZ. FERNANDO ZURICH ALIGN NETWOR 2230468104 10/7/2020 12/23/2020 WC
ROMAN. MATEO ZURICH MEDRISK 2230556342 8/23/2022 8/23/2022 WC
ROMAN. MATEO ZURICH N/A 2230556342 8/23/2022 8/25/2022 WC
ROSALES. ALFREDO ZURICH N/A 2230551548 7/20/2022 7/28/2022 WC
GARDUNO. RODOLFOZURICH MEDRISK 2840319305001 5/11/2021 5/13/2021 WC
ZEPEDA SOLORZANO. ZURICH N/A 2840328700001 1/18/2022 2/9/2022 WC

DUDLEY. JAMES ZURICH N/A 2840336321 8/10/2022 8/12/2022 WC
EXANTUS. JEREMIAH ZURICH N/A 2230529552 2/2/2022 2/14/2022 WC
NAQIB. SAMIULLAH ZURICH N/A 2230521725001 11/25/2021 12/1/2021 WC

claim received
FULFORD. JOSEPH ZURICH N/A 2230562684 9/19/2022 10/18/2022 WC

claim resubmitt
MANNING. CHRISTOPZURICH ALIGN NETWOR 2840337275 9/9/2022 10/31/2022 WC
JAMES. SULLIVAN ZURICH N/A 2840321371 6/24/2021 7/28/2021 WC

Claim submitted
ORDAZ. SILVESTRE ZURICH MEDRISK 2230467757 10/6/2020 11/17/2020 WC
TOLENTINO. JOSE ZURICH N/A 2840318799 4/27/2021 4/27/2021 WC

FRIAS. ROY ZURICH N/A 2840314246 12/21/2020 2/1/2021 WC
coding issue
THAPA. DEVI ZURICH N/A 2230493537 5/7/2021 5/7/2021 WC
ALPINE. ZACHARY ZURICH MEDRISK xxx-xx-9999 9/12/2022 9/14/2022 WC
MUCKLE. WINSTON ZURICH N/A 2840333099 5/18/2022 6/1/2022 WC
ARRIETA-JIMENEZ. CI ZURICH MEDRISK 2230487532 2/21/2021 3/9/2021 WC

RODRIGUEZ. MARTINZURICH N/A 2230528428 1/26/2022 1/28/2022 WC
RUIZ. JOSE RAMIRO ZURICH N/A 2230553911 8/5/2022 8/5/2022 WC
SOLIS. KEVIN ZURICH N/A WC 2230532323 2/25/2022 2/28/2022 WC
TREJO. JOSE ZURICH N/A 2230538870 4/18/2022 4/18/2022 WC

coverage issue
DOMINGUEZ. LUIS ALZURICH MEDRISK 2840308604 7/22/2020 7/22/2020 WC
LOVELACE. TRAVIS ZURICH MEDRISK 2840308041 7/6/2020 7/6/2020 WC

LOVELACE. TRAVIS ZURICH MEDRISK 2840308041 7/6/2020 7/8/2020 WC
DOI not reporte
HO. VU ZURICH N/A xxx-xx-5424 8/19/2022 8/26/2022 WC
PARKS. CHRISTIAN ZURICH N/A xxx-xx-0268 7/18/2022 7/18/2022 WC

BETSILL JR. MARION ZURICH MEDRISK 2840317765 4/2/2021 4/5/2021 WC
Duplicate claim
MILLER. RUSSELL ZURICH ALIGN NETWOR 2230544806 6/3/2022 6/3/2022 WC
faxed
ZAMORA. VICENTE NEW SOUTH CONN/A 2840269143 11/15/2021 11/18/2021 WC

ZAMORA. VICENTE NEW SOUTH CONN/A 2840269143 11/15/2021 12/5/2021 WC
CATO. BENJAMIN ZURICH N/A 2840316117 10/22/2020 3/22/2021 WC

ARRINGTON. WILLIA ZURICH MEDRISK 2840309630 8/13/2020 8/20/2020 WC
follow up mail
SCOTT. ELLAERY ZURICH N/A 2230522639 12/4/2021 12/4/2021 WC
EMRICK. STEPHEN ZURICH N/A 2840322197 7/12/2021 7/20/2021 WC
ORBEGOSO. DAX ZURICH N/A 2840308606 7/23/2020 7/27/2020 WC
ORBEGOSO. DAX ZURICH N/A 2840308606 7/23/2020 8/5/2020 WC

MALAGON. ANTONIOZURICH N/A 2840322381001 7/29/2021 8/2/2021 WC
SOLOMON. ROOSEVELZURICH MEDRISK 2840334346 6/21/2022 7/8/2022 WC
CHAVARRIA. ROBERT ZURICH N/A 2840311724 10/12/2020 1/27/2021 WC
JENKINS. HUNTER ZURICH N/A 2440334774 12/4/2020 1/27/2021 WC
KRAMER. JAROM ZURICH N/A xxx-xx-9999 9/17/2020 9/17/2020 WC
MANNING. CHRISTOPZURICH N/A 2840337275 9/9/2022 9/12/2022 WC
YEOMAN. ROLAND CARLSTAR GROUN/A 6/24/2021 6/25/2021 WC
DEFRANCE. BRANDONZURICH NORTH ALIGN NETWOR 2840339269 10/30/2022 10/31/2022 WC

DEFRANCE. BRANDONZURICH NORTH ALIGN NETWOR 2840339269 10/30/2022 11/2/2022 WC
GOINGS. CORRY ZURICH NORTH N/A xxx-xx-9999 6/28/2022 6/29/2022 WC
LIAN. LAL ESIS N/A xxx-xx-9346 12/8/2020 12/21/2020 WC

MILLENDER. TELACY ZURICH NORTH N/A xxx-xx-9019 6/14/2022 6/14/2022 WC
MILLENDER. TELACY ZURICH NORTH N/A xxx-xx-9019 6/14/2022 6/16/2022 WC
NANCE. MALACHI ZURICH NORTH N/A xxx-xx-9999 9/13/2022 9/16/2022 WC
SIMUNOVIC. PREDRA ZURICH NORTH N/A xxx-xx-0000 10/6/2021 10/7/2021 WC

STEPANOVA. LIDIYA ZURICH N/A 2840328840 1/14/2022 1/18/2022 WC
DAO. THUY ZURICH MEDRISK xxx-xx-0589 8/11/2022 8/22/2022 WC
DAO. THUY ZURICH N/A xxx-xx-0589 8/11/2022 8/24/2022 WC


GROVNER. DENA ZURICH N/A 2230520157 11/15/2021 12/23/2021 WC
inclusive
WELCH. COREY ZURICH N/A 2230457769 7/20/2020 7/22/2020 WC

GLOVER. JARVIS ZURICH N/A 2230536163 3/22/2022 3/30/2022 WC
inprocess
VEGA. ABEL SEDGWICK MEDRISK 4A2109C3G4400 9/10/2021 9/23/2021 WC
SAYLES. PETRONA ZURICH N/A 2840328984001 1/27/2022 2/7/2022 WC
SAYLES. PETRONA ZURICH N/A 2840328984001 1/27/2022 2/22/2022 WC
SAYLES. PETRONA ZURICH MEDRISK 2840328984001 1/27/2022 3/1/2022 WC

SAYLES. PETRONA ZURICH MEDRISK 2840328984001 1/27/2022 3/28/2022 WC
WASH. SHYDAE ZURICH N/A 2440348845 11/15/2021 11/15/2021 WC
WHITAKER. DANIELLEZURICH N/A 2230532989 1/27/2022 3/31/2022 WC
INGRAM. THADDIS ZURICH N/A 2840331123 3/17/2022 3/30/2022 WC
PAIGE. BILLY ZURICH N/A 2840324629 7/29/2022 7/29/2022 WC
PAIGE. BILLY ZURICH N/A 2840324629 7/29/2022 8/1/2022 WC
DELCID AMAYA. MAR ZURICH N/A 2230522293 12/1/2021 12/1/2021 WC

ROZANSKI. AIMEE ZURICH N/A 2230547819 6/22/2022 8/15/2022 WC
FOX. BLAZE ZURICH MEDRISK 2840335860 8/2/2022 8/19/2022 WC
WILLIAMS. ANNETTE N/A N/A xxx-xx-3170 9/11/2022 9/20/2022 WC
WILLIAMS. ANNETTE ZURICH N/A 2230559084 9/11/2022 9/28/2022 WC
PATTERSON. JENNIFE ZURICH N/A 2240447A72 1/11/2022 2/11/2022 WC

BELAY. HANA ESIS N/A 2840312696 10/26/2020 10/28/2020 WC
liability claim
WILLIAMS. JOHN ZURICH N/A 951017600 9/26/2022 9/27/2022 WC

medical record
CANALES. GILBERTO ZURICH N/A WC2230462909 8/31/2020 9/15/2020 WC

DAVEY. ANITA ZURICH MEDRISK 2840334412 6/23/2022 6/28/2022 WC
CELESTIN. LUCIEN ZURICH N/A 2840327222001 12/1/2021 12/7/2021 WC

GARCIA. KADINA ZURICH N/A 2230499027001 6/14/2021 6/18/2021 WC
ISHAG. GISMA ZURICH ALIGN NETWOR 2840312415 10/10/2020 2/10/2022 WC
MESSAM. PHYLLIS ZURICH N/A 2840321479 7/7/2021 10/23/2021 WC
MOIKI. MOIKI ZURICH N/A 2840327619 12/14/2021 1/7/2022 WC
OKPOKIRI. IYOWUNA ZURICH N/A 2840318163 4/12/2021 4/19/2021 WC
RAPXASH. STEVEN ZURICH N/A 2840331291 3/23/2022 3/25/2022 WC

UPSHAW. DAVID ZURICH N/A 2840328934 1/24/2022 1/31/2022 WC
ARNOLD. MELISSA ZURICH N/A 2840323686 8/29/2021 9/1/2021 WC
LONG. KAREN ZURICH N/A 2840326856 11/22/2021 11/30/2021 WC
LONG. KAREN ZURICH N/A 2840326856 11/22/2021 12/9/2021 WC
ROZANSKI. AIMEE ZURICH N/A 2230547819 6/22/2022 6/27/2022 WC
SAILES. CHERYL ZURICH N/A 2230545582 6/4/2022 7/18/2022 WC
BALL. BRIAN ZURICH MEDRISK 2840332500 5/2/2022 5/5/2022 WC
LOVEALL. BRIAN ZURICH N/A 2840319898001 5/20/2021 6/7/2021 WC

LOVEALL. BRIAN ZURICH N/A 2840319898001 5/20/2021 6/11/2021 WC
PARKER. AMANDA ZURICH N/A 2840328763 1/20/2022 2/21/2022 WC
PARKER. AMANDA ZURICH N/A 2840328763 1/20/2022 3/4/2022 WC
DUARTE. FERNELL ZURICH ALIGN NETWOR2230545465001 6/6/2022 6/7/2022 WC

WALTON JR. CHARLESZURICH NORTH N/A 2840329704 2/11/2022 3/2/2022 WC
modifier issue
SIMS. CHANTEL ZURICH ALIGN NETWOR 2230454136 6/20/2020 7/15/2020 WC
Medically Unlike Edi
MUSSER. AUSTIN ZURICH N/A 2840320346 6/4/2021 6/4/2021 WC

SULLIVAN. FREDERICKZURICH MEDRISK 2840334000 6/13/2022 6/13/2022 WC

appeal
ADAM. HALIMA ZURICH ALIGN NETWOR 2840325480 10/7/2021 2/4/2022 WC
COOPER. DERREK ZURICH N/A 2840326749 11/18/2021 11/22/2021 WC
HOBBS. DANTE ZURICH N/A 2840337554 9/14/2022 10/8/2022 WC
BOOKER. JAMES ZURICH N/A 2840316556 12/12/2020 12/14/2020 WC
FLORES. DANIA MARI ZURICH MEDRISK 2840334151 6/16/2022 7/5/2022 WC
GIRON. JORGE ZURICH MEDRISK 2840338217 9/30/2022 10/21/2022 WC

ASMELASH. TEKLEAB ZURICH N/A 2840338916 10/19/2022 10/24/2022 WC
non covered
KARIMI. FAHEMA ZURICH MEDRISK 2840310382 9/6/2020 2/21/2021 WC
paid
RASEKH. LAILUMA ZURICH N/A 2230543598 5/21/2022 5/24/2022 WC
WILLIS. DEBORAH ZURICH N/A 2840326881 11/23/2021 1/18/2022 WC
INGRAM. THADDIS ZURICH N/A 2840331123 3/17/2022 3/23/2022 WC
MALAGON. ANTONIOZURICH N/A 2840322381001 7/29/2021 7/29/2021 WC
PAYNE. TIMOTHY ZURICH ALIGN NETWOR2230519173001 11/9/2021 4/1/2022 WC
PAYNE. TIMOTHY ZURICH ALIGN NETWOR2230519173001 11/9/2021 6/3/2022 WC

GRAMAJO VASQUEZ. ZURICH MEDRISK 2840333987 6/10/2022 6/10/2022 WC
TORKE. IAN ZURICH MEDRISK 2840338799001 10/18/2022 10/18/2022 WC
MANNING. CHRISTOPZURICH N/A 2840337275 9/9/2022 10/17/2022 WC
WILLIAMS. VICTORIA ZURICH N/A 2840311556001 9/30/2020 10/6/2020 WC
WILLIAMS. ANNETTE ZURICH N/A 2230559084 9/11/2022 9/13/2022 WC
AQUAMINA. MACHIC ZURICH MEDRISK 2840336002 8/4/2022 8/8/2022 WC

TOLAR. OMEGA ZURICH N/A 2840317787 3/29/2021 6/15/2021 WC
BLANCO. MARIO ZURICH N/A 2230535438 3/21/2022 3/31/2022 WC
FAJARDO. HENRY ZURICH N/A 2230521836 11/30/2021 12/9/2021 WC
GARCIA. LAZARO ZURICH MEDRISK 2230487117 3/9/2021 3/9/2021 WC
FERNANDEZ. JOSE ZURICH MEDRISK 2840317972 4/2/2021 4/2/2021 WC
MALIZA. MEDIATRICEZURICH ALIGN NETWOR 2230486186 2/11/2021 3/22/2021 WC
ZEPEDA SOLORZANO. ZURICH N/A 2840328700001 1/18/2022 1/26/2022 WC
CHUWAN. YADI ZURICH MEDRISK 2840313937 12/14/2020 2/10/2021 WC
MAGAR. SAN ZURICH N/A 2840323261 8/19/2021 8/23/2021 WC
MAGAR. SAN ZURICH N/A 2840323261 8/19/2021 8/26/2021 WC
MCNEIL. KHARIN ZURICH N/A 2840316160-001 2/10/2021 2/10/2021 WC
OMAR. WASSAN ZURICH N/A 2840316469 2/16/2021 1/16/2022 WC
WARREN. STEVEN ZURICH N/A 22G71J987557 1/3/2022 1/3/2022 WC
reconsideration
PRADO. GABRIEL ZURICH N/A 2230484244 2/12/2021 2/12/2021 WC
RITCHIE. KYLE ZURICH N/A 2230512214 9/20/2021 9/20/2021 WC

timely
FAIRLEY. ADAIR TRAVELERS N/A FQV0595 9/8/2020 12/23/2020 WC
FAJARDO. JHUNIOR ZURICH N/A 2840313741 12/9/2020 12/11/2020 WC
VILLALVA. WILLIAM ZURICH N/A 2230462682 8/24/2020 8/31/2020 WC
VILLALVA. WILLIAM ZURICH N/A 2230462682 8/24/2020 9/2/2020 WC
JENKINS. FREDERICK SEDGWICK MEDRISK 402105C0C40000 5/6/2021 5/7/2021 WC

ONATE. JOSE ZURICH N/A xxx-xx-9999 8/12/2020 8/12/2020 WC
CLARK. CURTIS ENVIRONMENTALN/A xxx-xx-9999 7/27/2020 7/28/2020 WC
ESPINOSA SOLORZANO
ZURICH MEDRISK 2840308600 7/22/2020 7/23/2020 WC
RIVERA. TANAIRY ZURICH MEDRISK 2840309706 8/20/2020 8/31/2020 WC
CORTEZ. AURELIO ZURICH MEDRISK 2840312171001 10/20/2020 10/26/2020 WC

ISHAG. GISMA ZURICH N/A 2840312415 10/10/2020 1/19/2021 WC
Call
VEGA. ABEL SEDGWICK MEDRISK 4A2109C3G4400 9/10/2021 9/17/2021 WC
THOMAS. JEREMY ZURICH N/A xxx-xx-4236 11/2/2022 11/3/2022 WC
COOPER. JAQUARRI ZURICH N/A 2840327000 11/24/2021 11/30/2021 WC
FERGERSON. PAUL ZURICH ALIGN NETWOR 2840317712 3/24/2021 3/27/2021 WC
KOIRALA. DEVI ZURICH ALIGN NETWOR2840339001001 10/21/2022 10/31/2022 WC
MCWILLIAMS. NAZIREZURICH N/A 2840318123 4/11/2021 5/12/2021 WC
MUSTAJBASIC. SABAHZURICH ALIGN NETWOR 2230500533 6/24/2021 10/29/2021 WC
FRY-JONES. YAREE ZURICH MEDRISK 40337955 9/23/2022 9/23/2022 WC
HERNANDEZ ZAYAS. EZURICH MEDRISK 2840334782 7/5/2022 7/5/2022 WC

HERNANDEZ ZAYAS. EZURICH MEDRISK 2840334782 7/5/2022 7/7/2022 WC
PETTY. MESHA ZURICH NORTH N/A xxx-xx-7704 2/15/2022 2/15/2022 WC
PETTY. MESHA ZURICH NORTH N/A xxx-xx-7704 2/15/2022 2/17/2022 WC

Adjust
Amount Comments: Status Action
As per review, the claim was paid amt with the remaining
$234.18 balance $234.18. hence need to adjust the remaining. adjust Assistance
As per notes dated 11/18/2022 - "Called ZURICH @800-987-

3373 Spoke with Aldrin, Claim #2840338970 no adjuster
$208.46 details found. AR11182022." Need adjusterAssistance




3373 Spoke with JONALYN, CLAIM #2840339326, no adjuster
$709.51 details found and call reference #11019007 . AR11182022." Need adjusterneed to call
AS per notes dated-12/06/2022-Called ZURICH NORTH

AMERICA @719-590-8719 spoke with Jonalyn per rep
provided claim # of 17 Feb date of injury so Claim
#2840312869, No Adjuster details provided, Claim Mail Add
# PO BOX 968070 SCHAUMBURG, IL 60196-8070, Fax
$245.86 #8472408172. AR12062022. Need adjusterneed to call
As per review, the claim was paid amt with the remaining
$234.18 balance $234.18. hence need to adjust the remaining. adjust Assistance
Appeal upheld
Reconsideration submitted to Insurance. Called Zurich

@719-590-8719 speak with Joanline said, reconsideration
received on 08/25/2022 and processed on 09/08/2022 and
denied as Submitted documents was not supporting the
level of service and original decision is correct. Call ref#
$206.12 11256970. Appeal UphelCoding Assist
Reconsideration submitted to Insurance. Called Zurich

@719-590-8719 speak with Joanline said, reconsideration
received on 08/25/2022 and processed on 09/08/2022 and
denied as Submitted documents was not supporting the
level of service and original decision is correct. Call ref#
$206.12 11256970. Appeal UphelCoding Assist
CNOF
As per notes dated 08/17/2022 - "Called Zurich @719-590-

8719 Spoke with Ann Stated that claim not on file, need to
resubmit the claim to the Mailing Address :-PO BOX 968084
$225.79 SCHAUMBURG, IL 60196-8084. ref#10306847" Claim not on fTo be submit

8719 Spoke with Ann Stated that claim not on file, need to
resubmit the claim to the Mailing Address :-PO BOX 968084
$248.81 SCHAUMBURG, IL 60196-8084. ref#10306847" Claim not on fTo be submit
As per notes dated 08/09/2022 - REC`D CORR FROM ZURICH,

DOWNCODED OV FROM 99205 TO 99203 AND SUBMITTED A
RECONSIDERATION...MLA.. 8.9.22. Called Zurich @ 719-590-
8719 Spoke with Ben said, there is no corrected claim on file
and advised to fax# 847-240-8172 Attn: Zurich Bill review.
$302.43 Call ref# 11239245 Claim not on fTo Submit
Called Zurich @ 719-590-8719 Spoke with Ben said there is

no claim on file and advised to submit thru Fax# 847-240-
$260.58 8172. Call ref# 11243047. Claim not on fSubmitted
Called Zurich @ 719-590-8719 S/w Mars said Claim not on

file and mailling address PO BOX 968070, Schaumburg, IL
$208.46 60196-8070. Call ref# 11272501. Claim not on fTo be submit
As per notes dated 12/16/2022 - "Claim not on file need to

$608.87 Resubmit to usz.zurich.claims.documents@zurichna.com" Claim not on fTo be submit






Called Zurich @ 719-590-8719 Spoke with Marsh said, Claim

not on file and advised to fax. Fax# 847-240-8172. Call ref#
$187.40 11247786 Claim not on fTo Submit
As per notes dated-07/20/2020-Called Zurich @719-590-

8719 Spoke with Princess Stated that claim not on file, need
to resubmit the claim to the Mailing Address :-PO BOX
$473.47 968070 SCHAUMBURG, IL 60196-8070. ref#Ref#11141268 CNOF mail
As per notes dated-09/20/2022-Checked Daisy Bill website

and found that claim was not on file, so print the bill and and
$233.81 Fax #8472408172 CNOF need to call

8719 Spoke with Amber Stated that claim not on file, need
to resubmit the claim to the Mailing Address :-PO BOX
968084 SCHAUMBURG, IL 60196-8084. ref#10306847
$390.19 CNOF need to resubmit
Claim paid
Called Zurich @ 719-590-8719 Spoke with June processed on

09/21/2022 and Paid $133.56 on 09/27/2022 thru EFT#
487018240. It is a single. Bill ID - ZNMO-346375. Call ref#
$186.96 11236098. Claim Paid To be Posted
Called Zurich @ 719-590-8719 Spoke with June said Claim

procesed on 09/28/2022 and Paid $172.01 10/03/2022 thru
EFT# 4870156389. Bill ID - ZNMO-346784. Call ref#
$226.94 11236098 Claim Paid To be Posted
Called Zurich @ 719-590-8719 Spoke with June said, Claim

11/29/2022 processed on 12/13/2022 Paid $306.89 thru
sinngle EFT# 870163908. Bill ID - ZNGA-629378. Call ref#
$830.59 11236098 Claim Paid To be Posted
Called Zurich @ 719-590-8719 Spoke with Ben said, the

claim received and paid $111.15 Single EFT# 4870154714. on
$508.14 08/12/2022. Bill No. ZBNGA-617657. Call ref# 11239245 Claim Paid To be Posted
8719 speak with Angelina stated that this payment is a
combine payment from DOS 10/13/2022 to 10/22/2022
claim received on 03/16/2022 and processed on 8/14/2022
and the total allowed amount is $609.1 via check
4870145827, Hence need to post the payment.
$492.11 Ref#11140364" Claim paid To be posted

8719 speak with Angelina stated that this payment is a
combine payment from DOS 10/13/2022 to 10/22/2022
claim received on 03/16/2022 and processed on 8/14/2022
and the total allowed amount is $609.1 via check
4870145827, Hence need to post the payment.
$241.47 Ref#11140364" Claim paid To be posted
Called Zurich @ 719-590-8719 S/w Angelyn said Claim was

received and paid $52.77 thru EFT#4870159484 on
$62.08 10/12/2022. Call ref# 11271049. Claim Paid To be Posted
Called Zurich @ 719-590-8719 S/w Chris said Claim was

received and paid $178.24 thru EFT#4870116283 on
02/01/2021 and the copy of EOB requested thru Fax.. Bill
$209.69 ID#ZNGA-559639. Call ref# 11271220. Claim Paid To be Posted
As per notes dated 12/14/2022 - "As per Daisy bill claim was
paid $190.01 under ref# 00004870157075 . Hence, Need to
$450.28 post payment." Claim paid To be posted
$208.46 post payment." Claim paid To be posted
Called Zurich @ 719-590-8719 S/w jonalyn said

reconsideration was received and paid $16.79 thru
EFT#4870158198 on 09/27/2022 and the copy of EOB
requested thru Fax.. Bill ID#ZNGA-622072. Call ref#
$372.73 11271461. Claim Paid To be Posted
Called Zurich @ 719-590-8719 Spoke with Ben said the

reconsidertation received 08/26/2022 and processed
payment $142.59 on 09/08/2022 single EFT# 4870156611.
$167.75 Bill No. ZNGA-620359. Call ref# 11246427. Claim paid To be posted

reconsidertation received 08/26/2022 and processed
payment $166.44 on 09/08/2022 single EFT# 4870156612.
$206.12 Bill No. ZNGA-620377. Call ref# 11246427. Claim paid To be posted
Called Zurich @ 719-590-8719 Spoke with Albrin said the

claim processed on 08/26/2022 and Paid $75.02 thru single
$206.12 EFT and reqiestes copy of EOB thru fax. Call ref# 11247935. Claim paid To be posted
As per notes dated 11/02/2022 - "Checked Daisy bill web
portal and found that claim was processed on 08/31/2022
and the paid amount $168.33 with the payment reference#
$214.10 00004870155985 hence need to post the payment." Claim paid To be posted
As per notes dated 11/23/2022 - "Checked Daisy Bill website

and found that claim was received and processed on
03/03/2022 and the total allowed amount is $7.46 via check
and the payment reference# 00004870142850 , hence need
$244.44 to post the payment." Claim paid To be posted

8719 speak with Chris stated that claim receive on
01/24/2022 and process on 02/01/2022 and the total
allowed amount is $59.40 via EFT#00004870141294 cashed
$206.12 on 02/03/2022, Hence need to poste the payment." Claim paid To be posted
As per notes dated 09/20/2022 - "Checked Daisy Bill website

06/16/2022 and the total allowed amount is $52.77 via
check and the payment reference# 00004870150096, hence
$99.48 need to post the payment." Claim paid To be posted
claim received
Called Zurich @ 719-590-8719 Spoke with Ben said claim

received on 12/06/2022 and inprocess. Bill #. ZNGA-630109.
Rep advised to call back after 30 buss days. Call ref#
$260.58 11243047. Claim receiveClaim inproce
received on 12/02/2022 and still under process. Hence, Need
$1.012.13 to allow some more time" Claim receiveClaim inproce
claim resubmitted
As per notes dated-12/20/2022-As per daisy bill claim was

$208.46 denied. Hence, Reconsideration sent via daisy bill claim resubmAssistance
As per review, the claim was resubmitted to ZURICH
REF#08379202
$206.12 resubmited need to call

Claim submitted
As per notes dated-06/17/2021-CALLED ZURICH 719 590-
8719 AND SPOKE W/ MARIA WHO STATED THAT THE BILL
WAS DENIED BC THE DOCS DID NOT SUPPORT THE BILL.
DOWNCODED AND FAXED BILL TO 847 240-8172 FOR RECON
, CALL REF# 07839911. EB 06/17/21
$209.69 claim submittneed to call

8719 speak with princess stated that claim denied as lack of
medical records that satisfied the level of services. confirm
the claim Mailing Address-PO Box 968070. Schaumburg, IL
60196-8070. and Fax #8472408172. PrintZURICH
As per notes dated-06/22/2021-CALLED bill and@ 719 590-
faxed.ref#10493118
8719 AND SPOKE W/ VIVIAN WHO STATED THAT THERE`S
NO BILL ON FILE. FAXED BILL TO 847 240-8172 , CALL REF#
$415.21 07860811. EB 06/22/21 claim was su need to call
$225.31 claim was su need to call
coding issue

8719 speak with Princess stated that the complete claim was
denied as Code 99205 does not support the level of service,
Code 99071 denied as MUE denial, 73130 denied as medical
necessity, A4570 and A4209 also denied as MUE Denial so
send reconsideration for following denials via Daisy Bill.
$444.28 Ref#11141268 code issue Coding Assistance
As per notes dated-11/23/2022-Checked Daisy Bill Web

Portal website found claim received on 10/05/2022 and
denied as the Workers` compensation jurisdictional fee
schedule adjustment. Notes: This code replaces deactivated
$208.46 code W1. code issue Coding Assistance
As per notes dated-07/29/2022-Checked daisy bill web

found claim processed and denied on 07/08/2022 as
Workers` compensation jurisdictional fee schedule
adjustment. Notes: This code replaces deactivated code W1,
$208.46 hence escalated to Monique for further action. coding issue Coding Assistance
As per notes dated-05/13/2021-CALLED ZURICH SPOKE W/

PETTER WHO STATES CLAIM WAS DENIED BC ICD CODE DID
NOT MATCH BODY PART. CORRECTED CODE AND FAXED BILL
TO 847 240-8172 FOR BILLING. REF3076984141. EB 05/3/21
$167.75 code issue Coding Assistance
Called Zurich @ 719-590-8719 Spoke with Ben said claim
received on 11/17/2022 and denied on 11/23/2022 as
Document submitted doesn’t support the level of service.
$260.58 Bill# ZNGA-628645. Call ref# 11243047. CPT Code Coding Assist
As per notes dated 07/27/2022 -Checked daisy bill web

Workers` compensation jurisdictional fee schedule
adjustment. Notes: This code replaces deactivated code W1,
$257.65 hence escalated to Monique for further action. CPT Code Coding Assist
Called Zurich @ 719-590-8719 Spoke with Marsh said,

09/15/2022 09/21/2022 denied as Level of code is not
supporting for the submitted documents. Rep advised to
submit reconsideration thru Fax# 847-240-8172 .Bill# ZNGA-
$506.51 622432. Call ref# 11243339. CPT Code Coding Assist


Called Zurich @ 719-590-8719 Spoke with Spinces said,

Claim received on 08/25/2022 and denied on 08/31/2022 as
Document doesn’t not support the level of service. Bill No.
ZNGA-620009. Can fax the appeal includes appeal letter.
$206.12 Fax# 847-240-8172. Call ref# 11244704. Dx code Coding Assist
As per notes dated 11/30/2022 - "Called to Zurich @ 719-

590-8719 speak with Mark stated that as injury is on lower
part and service perform on Shoulder. so there is no change
yet need coding assistance, Escalated to Monique for the
$747.62 next course of action, Ref#10843174" Dx code Coding Assist
As per notes dated 11/30/2022 - "Called to Zurich @ 719-

590-8719 speak
As per notes with
dated Mark stated
11/30/2022 that asto
- "Called injury is on
Zurich @ lower
719-
part and service
590-8719 perform
speak with Markonstated
Shoulder.
that so there is
as injury is no
on change
lower
yet
partneed coding assistance,
and service perform onEscalated
Shoulder.to soMonique
there is noforchange
the
$206.12 next course of action, Ref#10843174"
yet need coding assistance, Escalated to Monique for the Dx code Coding Assist
$319.93 next course of action, Ref#10843174" Dx code Coding Assist
coverage issue

8719 Spoke with Brix Stated that claim denied as service not
$583.76 covered or policy not active so need to contact employer." Coverage Iss Client Assist

8719
As perspeak
noteswith Joycelyn
dated stated- that
12/07/2022 claim
"Called denied
Zurich as Drug
@719-590-
test positive so escalate to Monique for the next course
8719 speak with Joycelyn stated that claim denied as Drug of
$534.62 action Ref#11138355"
test positive so escalate to Monique for the next course of Coverage Iss Client Assist
$128.32 action Ref#11138355" Coverage Iss Client Assist
DOI not reported
Called ZURICH @719-590-8719 spoke with Ben no injury

reported so called employer @ 678-333-0891 and transfer
my call to Stacy, Ph #6782871959 but not provided any
details he said send invoice as you are sending but did not
$621.32 provide any Mail ID. AR12152022. DOI - Not Re Assistance


Called Zurich @ 719-590-8719 Spoke with Spinces said,
Called ZURICH @719-590-8719
Claim received S/w Ben
on 05/21/2021 denied onper rep injuryas
05/26/2021 not
reported yet.occur
Injury didn’t Calledinemployer
the courseCMC COMMERCIAL
of employent. RepMETALS
advised
$485.05 @ 678-333-0891
to check Called and
with employer left VM.Bill No# ZNGA-572283.
or patient. DOI - Not Re VM - Followu
$167.75 Call ref# 11244704. DOI - Not Re Assistance
Duplicate claim
As per notes dated-12/07/2022-Checked Daisy Bill Web
Portal Found Claim reject as Duplicate Payor but check on
Amount Comments:
EMR other DOS paid with the same Claim# and payor Status Action
$482.20 resubmit the claim by Daisy Bill. duplicate cla Assistance
faxed

8719 speak with Princess stated that claim not on file
confiirm the fax#8472408172. Print bill and
$245.66 faxed.ref#10479416 faxed need to call
8719 speak with Princess stated that claim not on file
confiirm the fax#8472408172. Print bill and
$107.28 faxed.ref#10479416 faxed need to call

8719
As perAND SPOKE
notes TO JOEY WHO STATE THAT
dated-06/15/2021-CALLED NO @
ZURICH BILLS
719ON
590-
FILE.
8719 AND SPOKE W/ BARRY WHO STATED THAT THERE`S. NO
FAXED BILLS TO 847 240-8172 , CALL REF#7703630 EB
$225.31 05/14/21
BILL ON FILE. FAXED BILL TO 847 240-8172 , CALL REF# faxed need to call
$167.75 07831698. EB 06/15/21 faxed bill need to call
follow up mail

8719 Spoke with James Stated claim denied as injury is not
covered under employer contract, so print the bill and Email
to Employer at yashira_dilme@tjx.com, need to wait for the
$542.83 response Follow up maiAssistance


As per review, claim was printed and mailed to ZURICH PO

$6.00 BOX 968070. therefore need to allow some time to process . Follow up maiAssistance
As per notes dated-09/22/2021-SENT EMAIL TO DANIEL

MAXSON @ NEW SOUTH CONSTRUCTION, WITH A
SPREADSHEET OF PAST DUE BILLS THAT ARE 300+ DAYS OLD,
AS WELL AS SPREADSHEET WITH TOTAL BALANCES DUE.
$225.31 LG 9/22/21 Follow up maineed to call
As per notes dated-09/22/2021-SENT EMAIL TO DANIEL

MAXSON @ NEW SOUTH CONSTRUCTION, WITH A
SPREADSHEET OF PAST DUE BILLS THAT ARE 300+ DAYS OLD,
AS WELL AS SPREADSHEET WITH TOTAL BALANCES DUE.
$220.81 LG 9/22/21 Follow up maineed to call
As per review, CLAIM PRINTED and mailed to ZURICH PO
$231.02 BOX 968070 Follow up maiAssistance

8719 speak with Myra stated that for the claim deniel reason
shared the claim details with pt, Name and DOS along with
Claim#Email the spreadsheet for claim status @
Zurichmph@Mitchell.com for claim status, Ref#
$294.07 Follow up maiAssistance
As per notes dated-CALLED ZURICH @ 719 590-8719 AND

SPOKE W/ JULIEN WHO STATED THAT THERE`S NO BILL ON
FILE. FAXED BILL TO 847 240-8172 , CALL REF# 07840287. EB
$69.19 06/17/21 Follow up maineed to call
As per notes dated-06/22/2022-CALLED ZURICH @ 719 590-
8719 AND SPOKE W/ SHAIRA WHO STATED THAT THERE`S
NO BILL ON FILE. FAXED BILL TO 847 240-8172 , CALL REF#
07857047. EB 06/24/21
$69.19 Follow up maineed to call
As per notes dated-12/06/2022-Check EMR and found that

they are paying the bills by themselves and need to send the
bills at email-Hensley@Daviscos.com. Therefore printed the
bill and email out to the employer.
As per notes dated -12/20/2020-As per daisy bill claim was

$208.46 denied. Hence, Reconsideration sent via daisy bill Follow up maiAssistance
As per notes dated-09/06/2022-called up Employer @770-

288-8892 speak with HR Dejane Kletke stated that that claim
will be paid Inhouse so print the bill and Email to
$610.62 DCHR@CARLSTAR GROUP.com Follow up maiAssistance


As per notes dated-11/18/2022-Per review checked on daisy

bill and found that claim got rejected for Patient cannot be
identified as our insured. So email sent to employer
NOVOLEX COMPANY - BAGCRAFT - NORCROSS manager @
$559.38 anthony.combs@novolex.com Follow up maineed to call
As per notes dated-11/18/2022-Per review checked on daisy
bill and found that claim got rejected for Patient cannot be
identified as our insured. So email sent to employer
NOVOLEX COMPANY - BAGCRAFT - NORCROSS manager @
$219.96 anthony.combs@novolex.com Follow up maineed to call
As per notes dated-11/30/2022-As per email received from

the Maria, Barrios stating that they need the invoice in PDf
format. Therefore created an Invoice in PDF format and
email out @Ap.Invoice@Novolex.com





NOVOLEX COMPANY - BAGCRAFT - NORCROSS paid bill
Inhouse so Email bill to Employer and need to send the bills
at email-AP.INVOICE@NOVOLEX.COM. Therefore printed the
$460.93 bill and email out to the employer. Follow up maiAssistance

As per notes dated-11/04/2022-check on EMR found that

claim Billed to Employer paid In House so print the Bill and
$301.53 Emailed to Employer @annhall@ckspackaging.com Follow up maiAssistance
As per notes dated-11/04/2022-check on EMR found that

claim Billed to Employer paid In House so print the Bill and
$208.46 Emailed to Employer @annhall@ckspackaging.com Follow up maiAssistance
As per notes dated-10/27/2022-Called to Zurich @719-590-

8719 speak with Myra stated that the injury is not reported
yet so need to contact Employer, Called to employer @770-
300-6820 but not active on call so leave voice mail found an
Email:-AP.INVOICE@NOVOLEX.COM so print the bill and sent
$294.07 to employer. Follow up maineed to call

employer paying the bills by themselves and need to send
the bills at email-ap.invoice@novolex.com. Therefore
printed the bill and email out to the employer.




8719 speak with Myra stated that for the claim deniel reason
shared the claim details with pt, Name and DOS along with
Claim#Email the spreadsheet for claim status @
$229.12 Zurichmph@Mitchell.com for claim status, Ref#10597384" Need to follo Assistance
As per notes dated 10/25/2022 - "Check in EMR found that

injury notv reporterd yet so called to employer but still call
reoted to Voice mail so found an email ID
Twita_Handerson@TJX.com Print the bill and faxed to
$714.15 Employer" Need to follo Assistance

$208.46 Employer" Need to follo Assistance

$219.96 Employer" DOI - Not Re Assistance



8719 speak with Aldrin stating that claim denied as lack of
As per notes
medical dated
records that10/25/2022 - "Check
satisfied the level ofinservices.
EMR found that
confirm
injury notv reporterd yet so called to employer but
the claim as check last reconsideration Sent on 08/23/2022still call
but they dnt receive so this time resubmit the required
Twita_Handerson@TJX.com
Documents Via Email Print the bill and faxed to
$208.46 Employer"
@`USZ.ZURICH.CLAIMS.DOCUMENTS@ZURICHNA.COM. DOI - Not Re Assistance
$287.81 Print bill and Email to the insurance." Need to follo Assistance
inclusive
As per notes dated 07/20/2022 - "Checked daisy bill found
claim processed and denied on 04/26/2022, CPT # 99214
denied as This code replaces deactivated code W1, checked
Called Zurich
and found @service/procedure
This 719-590-8719 Spoke with said
requires thatBixx and
a qualifying
asked about the claim sent for reprocess. Rep reviewed
service/procedure be received and covered. The qualifying the
last call ref# and said the claim was not sent for
other service/procedure has not been received CPt # A6454reprocess
and there
denied is nobenefit
as The output.for
Sending to supervisor
this service review.
is included in theIt will
$378.50 take 20-25 buss days. Call ref# 11237794.
payment/allowance for another service/procedure, so Inclusive Sent for repr
$273.79 escalated the claim for coding assistance." inclusive Coding Assist
inprocess
As per notes dated 08/03/2022 - "As per review found that

claim was billed to , called ZURICH @719-590-871 s/w Peter
stated that claim was received on and still in review, hence
need to allow 30 to 45 days to process claim, call ref #
$206.12 09108493" Inprocess Calling

8719 speak with Jimmy stated that receive on 04/16/2022
and under review and need to allow some more time
$206.12 ` inprocess need to call



8719 speak with Angelina stated that claim Denied ad
submitted documents dose not support the level of services
so send a reconsideration Via Daisy bill, Hence need to allow
$484.52 some time Ref#11140364 inprocess Assistance
As per noted dated-09/26/2022-Called Zurich @719-590-

8719 speak with Zary stated that claim denied as Medical
necessity, In submitted documents already mention that CPT
99215 is medically necessary inform to the Zary same and
zary send this claim to reprocess will take 7-10 days.
$314.15 ref#10592089 inprocess Coding Assistance
AS per notes dated-11/03/2022-Check on daisybill found

that Claim rejected due to invalid information so
resubmitted via Daisybill hence eed to allow some more time
$206.12 inprocess need to call

8719 found that Injury is not reported yet also check with Pt
social and name search nothing got found so Email Bill to
employer for payment status at
Dmaxson@newsouthconstruction.com, Need to allow some
time.
$523.81 inprocess Assistance

8719 found that Injury is not reported yet also check with Pt
social and name search nothing got found so Email Bill to
employer for payment status at
Dmaxson@newsouthconstruction.com, Need to allow some
time.

8719 speak with Chris stated that claim denied as Date of
service is prior to Date of injury so correct the claim form
and resubmit to insurance via Fax-8472408172, Need to
$983.40 allow some more time, Ref#11124438 inprocess Assistance
As per notes dated-10/18/2022-Checked Daisy bill Found
Claim was billed with correct pair and claim number
2230547819 on 09/22/2022 and accepted on 9/25/2022,
$208.46 need to allow some time. inprocess Assistance
As per notes dated-11/12/2022-Checked Diasy bill web

portal and found that claim was receive on 08/25/2022 and
is currently in process, hence need to allow more time.

As per notes dated-11/14/2022-Claim In Process In Process
Check on daisy Bill found that claim process receive date is
10/15/2022 and process on 10/18/2022 with the ref#. Hence
need to allosw some time CC
$272.39 Inprocess Assistance

As per notes dated-11/14/2022-Claim In Process In Process
Check on daisy Bill found that claim process receive date is
10/15/2022 and process on 10/18/2022 with the ref#. Hence
need to allosw some time CC
$244.79 Inprocess Assistance
As per notes dated-09/12/2022-Checked daisy bill website

found claim received on 9/02/2022 and accept on 9/06/2022
stillper
As under review,
notes datedso need to allow some more
-09/22/2022-Checked daisy time to
bill website
$235.09 process the bill.
found claim received on 08/01/2022 still under review, so Inprocess Assistance
$167.75 need to allow some more time to process the bill. Inprocess Assistance
liability claim
Called Zurich @ 719-590-8719 Spoke with Spinces said this is

Liablity claim and and advised to contact the Adjustor.
Correct Claim# 9510176600. Call ref# 11248168. Called
$440.64 Adjustor and left message. Liablility Clai VM - Followu
Called Zurich @ 719-590-8719 Spoke with Spinces said this is

Liablity claim @
Called Zurich and719-590-8719
and advised to contact
Spoke withthe Adjustor.
Spinces said this is
Correct Claim# 9510176600. Call ref# 11248168. Called
Liablity claim and and advised to contact the Adjustor.
$208.46 Adjustor and left
Correct Claim# message. Call ref# 11248168. Called
9510176600. Liablility Clai VM - Followu
$208.46 Adjustor and left message. Liablility Clai VM - Followu
medical record

reconsideration received on 11/04/2021 and denied on
11/16/2021 for requesting additional documents. Rep told to
fax the documents to 847-240-8172 along with the appeal
$281.64 letter. Call ref# 11239245 Medical reco Appeal Pendi
8719 Spoke with Joel stated that claim receive on
09/15/2022 and denied as submitted documents doesn`t
support the medical necessity of billed procedure and lack of
information , Need to resubmitted Via Fax #8472408172 and
$208.46 attn to bill review department." Medical reco Coding Assist

8719 Spoke with Joel stated that claim receive on
09/15/2022 and denied as submitted documents doesn`t
support the medical necessity of billed procedure and lack of
information , Need to resubmitted Via Fax #8472408172 and
$260.58 attn to bill review department." Medical reco Coding Assist

Additional information has been requested from the
member. The charges will be reconsidered upon receipt of
that information, so created an appeal and submitted via
$406.96 daisy bill along with medical records. AK07192022" Medical reco Calling

Additional information has been requested from the
member. The charges will be reconsidered upon receipt of
that information, so created an appeal and submitted via
$69.19 daisy bill along with medical records. AK07192022" Medical reco Calling

reconsidertation received on 08/26/2022 and denied on
09/05/2022 need additional documention to process but
they don’t have exact detail what type of document needed.
$206.12 Bill No. ZNGA-620367. Call ref# 11246427. Medical reco Coding Assist
Called Zurich @ 719-590-8719 Spoke with Chris said,

received reconsideration on 11/07/2022 and denied on
11/11/2022 as Documentation doesn’t not suppor the level
$208.46 of service. Bill No. ZNGA-627552 Medical reco Coding Assist
Called Zurich @ 719-590-8719 Spoke with Chris said,

received reconsideration on 09/14/2022 and denied on
09/22/2022 as Documentation doesn’t support the level of
$481.76 service. Bill No. ZNGA-622136. Call ref# 11246852. Medical reco Coding Assist
As per notes dated 12/06/2022 - "Called to Zurich @719-
590-8719 Speak with Denver stated that claim is denied as
medical documentation does not support the level of
services so need to send this claim again so resubmit the
$311.21 claim again Ref#11129316" Medical reco Coding Assist

8719 speak with Anjelyn stated that claim denied as lack of
the claim Mailing Address:-PO Box 968070. Schaumburg, IL
60196-8070. and Fax #8472408172. Print bill and
$359.76 faxed.ref#10384805" MR Faxed Calling

8719 speak with Chris stated that claim denied as lack of
Called Zurich @ 719-590-8719 Spoke with Albrin said,

09/07/2022 denied as Medical records doesn’t not
substaniate the level of service. Bill no # ZNGA-620285.Call
$69.88 ref# 11247935. Medical reco Coding Assist


Called Zurich @ 719-590-8719 Spoke with Marsh said

11/14/2022 as Medical records not supporting the level of
service. Requestes copy of EOB to an appeal. Fax# 847-240-
$243.52 8172. Call ref# 11247786 Medical reco Coding Assist

8719 speak with Jocelin stated that claim denied as lack of
medical records that satisfied the level of services ,
reconcideration send via Fax on Fax#8472408172
Ref#10596185.
$206.12 MR request Assistance

As per notes dated-09/01/2022-Checked daisy bill Found
Claim denied as lack of medical records that satisfied the
level of services need to send reconsideration and Attn to
$206.12 reconsideration department, Need to allow some time. MR request Assistance

Claim denied as lacks information or has submission/billing
$206.12 error the claim via Daisy bill medical recorAssistance

$206.12 faxed.ref#10384805 medical recorAssistance

$206.12 faxed.ref#10384805 medical recorAssistance
As per notes dated-10/18/2022-Checked daisy bill web

Claim/service lacks information or has submission/billing
error(s). Bill Review did not reimburse the submitted
procedure code or units, so escalated to Monique for further
$231.46 action, medical recorneed to call

Claim denied as lacks information or has submission so rebill
the clam with supporting documents
$208.46 medical recorAssistance
As per not4es dated-09/21/2022-Called Zurich @719-590-

8719 speak with Jenelyn stated that claim denied as lack of
the claim Mailing Address-PO Box 968070. Schaumburg, IL
60196-8070. and Fax #8472408172. Print bill and faxed.
ref#10562749

error the claim Mailing Address:-PO Box 968070.
Schaumburg, IL 60196-8070. and Fax #8472408172. Print bill
$206.12 and faxed medical recorAssistance
error the claim Mailing Address:-PO Box 968070.
Schaumburg, IL 60196-8070. and Fax #8472408172. Print bill
$145.27 and faxed medical recorAssistance

8719 speak with peter stated that Claim denied as medical
records dose not support the level of service so confirm the
Mailing Address:-PO Box 968070. Schaumburg, IL 60196-
8070. and Fax #8472408172 and Print the bill and fax to the
Insurance, Need to allow some time.ref#10486979

8719 speak with peter stated that Claim denied as medical
records dose not support the level of service so confirm the
Mailing Address:-PO Box 968070. Schaumburg, IL 60196-
8070. and Fax #8472408172 and Print the bill and fax to the
Insurance, Need to allow some time.ref#10486979

8719 Speak with Christal stated that claim denied as
submitted medical records dose not support the level of
services so print the medical records along with the bill and
send
As perit notes
to Zurich bill review departmentZurich
dated-09/26/2022-Called Via @719-590-
Fax#8472408172, Hence need to allow some
8719 speak with Marz stated that claim Denied time.
as lacks
information or has submission/billing error the claim
$245.37 confiirm the fax#8472408172. Print bill and medical recorAssistance
$221.85 faxed.ref#10589151
As per notes dated-06/22/2022-CALLED ZURICH 719 590- Medical reco Coding Assistance
modifier issue
8719 AND SPOKE W/ SHAIRA WHO STATED THAT THE BILL
WAS DENIED BC OF INCORRECT MODIFIER. REMOVED AND
Amount Comments:
FAXED BILL TO 847 240-8172 FOR RECON , CALL REF# Status Action
$225.31 07858420. EB 06/22/21 modifier issu need to call
Medically Unlike Edits
Called Zurich @ 719-590-8719 Spoke with said Bixx said the

claim paid but the Line items 99050, A5500, 99000 denied
for Medically unlike edits. Rep advised to send an appeal
thru Fax# 847-240-8172 with an appeal letter. Call ref#
$110.69 11237183 MUE Appeal Pendi
As per notes there is reconsideration submitted. Called to
Zurich @719-590-8719 Speak with Ben and inquired the
status of Reconsideration. rep reviewed and said there is no
reconsideration and advised to fax with an appeal letter. Call
$336.77 ref# 11256858 MUE Pending Appe

Zurich @719-590-8719 Speak with Ben and inquired the
status of Reconsideration. rep reviewed and said there is no
reconsideration and advised to fax with an appeal letter. Call

Zurich
As per @719-590-8719 Speak with Ben
notes there is reconsideration and inquired
submitted. theto
Called
status
Zurich @719-590-8719 Speak with Ben and inquired theis no
of Reconsideration. rep reviewed and said there
reconsideration and advised
status of Reconsideration. reptoreviewed
fax with an
andappeal letter.is Call
said there no
$244.79 ref#
reconsideration and advised to fax with an appeal letter. Call MUE
11256858 Pending Appe
appeal
As per notes dated 11/30/2022 - "Check on Daisy Bill Found

that claim denied as additional information so reprocess the
claim with an denied EOR and appeal letter, Hence need to
$287.81 allow some more time." Need to foll Assistance
As per notes dated 11/17/2022 - "Check on Daisy Bill found

that claim Denied as incompleted Information so appeal the
denied claim via daisy bill, therefore need to allow some
$206.12 more time." Need to foll Assistance
As per notes dated 11/09/2022 - "Checked Daisy Bill Web

Portal Found Claim Denied as medical necessity so send
reconsideration to insurance, need to allow some more
$99.48 time." Need to foll Assistance
Called Zurich @719-590-8719 s/w Sho said CPT 99204

denied lack of medical records & CPT 99071 denied as
Medically Unlike Edits Fax#847-240-8172. Bill ID#ZNGA-
$259.82 572540 Call ref#11272089. Need to sendAssistance
Called Zurich @719-590-8719 s/w Ben said we did not

received any Medical document thru fax, rep advise to send
again the appeal Fax#847-240-8172. Bill ID#ZNGA-620993
$208.46 Call ref#11271625. Need to sendAssistance
Called Zurich @ 719-590-8719 S/w Peter said CPT 99214

denied lack of medical records Fax#847-240-8172. Bill
$260.58 ID#ZNGA-627609. Call ref# 11272242. Need to sendAssistance
$208.46 Called Zurich @ 719-590-8719 S/w Sho said CPT 99214 deniedNeed to sendAssistance
non covered
$99.89 As per notes dated-06/22/2021-CALLED ZURICH @ 719 590-8 Non covered need to call
paid
AS per notes dated-09/12/202-Checked Daisy Bill web portal

and found that claim was received and procesed on
06/17/2022 and the paid amount $52.77 with the payment
reference# 00004870150311 hence need to post the
payment.
$99.48 paid need to post

8719 speak with benz stated that claim receive on9/13/2022
and process on 9/16/2022 and the total allowed amount is
$59.40 via EFT# 48070157901 cashed on 9/23/2022, Hence
$287.81 need to poste the payment. Ref#10591530 paid need to post
As per notes dated-1/03/2022-Checked Daisy bill web found

claim processed and paid on 05/03/2022 and paid $237.83
under payment ref# 00004870146889, so need to post the
$380.86 payment. paid need to post
As per review,claim was processed and requested for
$270.23 reconsideration paid not posted
As per notes dated-10/31/2022-Checked Daisy bill and found

that claim was receive and processed on 08/22/2022 and the
total allowed amount $470.66 with the payment reference#
$291.01 00004870155232 hence need to post the payment. paid need to post
As per notes dated-11/12/2022-Checked Daisy bill and

found that claim was receive and processed on 08/23/2022
and the total allowed amount $246.60 with the payment
reference# 00004870155337 hence need to post the
As per notes dated-Checked Daisy Bill website and found

that claim was received and processed on 05/06/2022 and
the total allowed amount is $59.40 via check and the
payment reference# 00004870147278, hence need to post
$69.88 the payment. paid need to post

and found that claim was processed on 06/23/2022 and paid
amount $52.77 payment reference#00004870150645, hence
$62.08 need to post the payment. paid need to post
8719 Spoke with Darel stated that claim received on
09/02/2022 and processed on 09/27/2022 and the total
allowed amount is $275.50 via check 4870158170, then we
send a reconsideration so the reconsideration claim received
on 09/30/2022 and processed on 10/20/2022 and the total
allowed amount is $642.16 via check 4870160070 Hence
need to post the payment.

As per notes dated-12/20/2022-As per Daisy bill claim was
paid $702.07 under Ref# 00004870163269. Hence, Need to
post payment.
As per notes dated-12/20/2022-Per Daisy bill Claim was paid

$149.25 under Ref# 00004870161536. Hence, Need to post

8719 speak with benz stated that claim receive on6/30/2022
and process on 7/14/2022 and the total allowed amount is
$135.46 via EFT# 48070128365 cashed on 7/19/2022, Hence
need to poste the payment. Ref#10591530
As per notes dated -12/14/2022-As per Daisy bill claim was

$360.22 post payment.` paid need to post

that claim was processed on 08/25/2022 and the paid
amount $20.80 with the payment reference#
$250.35 00004870155456 hence need to post the payment. paid need to post

00004870155967 hence need to post the payment.
00004870156851 hence need to post the payment.

08/30/2021 and the total allowed amount is $59.40 via
check and the payment reference# 00004870131208 , hence
$69.88 need to post the payment. paid need to post
$257.65 Paid and Closed Paid and Closclosed
$211.26 Claim Paid and Closed Paid and Closclosed
$253.82 Claim was paid and already closed Paid and Closclosed
$281.64 Claim Paid and Closed Paid and ClosClosed
$99.97 Claim
As perwas paidthe
review, andclaim
already
wasclosed
paid amt with the remaining Paid and Closclosed
$0.09 balance $0.09 hence need to adjust the remaining balance. paid/small baneed to verify and post the payment
reconsideration

8719 speak with Jocelin stated that claim denied as lack of
medical records that satisfied the level of services ,
reconcideration send via Fax on Fax#8472408172
$337.80 Ref#10596185" MR faxed Calling
As per notes dated-09/26/2022-Checked Diasy bill and found

that bill denied as Claim/service lacks information or has
submission/billing error(s). So appeal sent with denied CPT
$408.47 along with Appeal form and denied EOB ReconsideratAssistance

8719 AND SPOKE W/ REP WHO STATED THAT THE BILL WAS
DENIED BC THE DOCS DID NOT SUPPORT THE BILL.
$167.75 , CALL REF# 07857764. EB 06/22/21 MR faxed need to call
$167.75 As per notes dated-06/22/2022-CALLED ZURICH 719 590-87 reconsideratineed to call
timely
As per notes dated 08/31/2021 - "CLAIM PRINTED AND
MAILED TO TRAVELERS P.O.BOX 660456 DALLAS,TX
$30.00 75266....LF 08/31/21" and we already crossed the TFL Timely To Adjust
As per notes dated 05/18/2021 - "CALLED ZURICH 719 590-

8719 AND SPOKE TO ELLE WHO STATE THAT THE BILL WAS
DENIED BC THE DOCS DID NOT SUPPORT THE BILL.
, CALL REF# 07717782. EB 05/18/21" and we already crossed
$209.69 the TFL Timely To Adjust
As per notes dated 05/19/2021 - "SPOKE TO MYA WHO

STATED THAT THE CLAIM WAS DENIED DUE TO INJURY DID
NOT ARISE DURING COURSE OF EMPLOYMENT.
$323.28 REF#07722542 EB5/19/21" and we already crossed the TFL Timely To Adjust
As per notes dated 05/19/2021 - "SPOKE TO MYA WHO

STATED THAT THE CLAIM WAS DENIED DUE TO INJURY DID
NOT ARISE DURING COURSE OF EMPLOYMENT.
$209.69 REF#07722542 EB5/19/21" and we already crossed the TFL Timely To Adjust
CPT's A9273 & A6454 denied, we are got paid all other codes
$104.54 and we already crossed the TFL Timely To Adjust
$259.82 As per review, CNOF and we already crossed the TFL Timely To Adjust
As per notes dated 06/25/2021 - "CALLED ZURICH 719 590-

8719 AND SPOKE W/ PRINCESS WHO STATED THAT THE BILL
WAS DENIED BC THE DOCS DID NOT SUPPORT THE BILL.
, CALL REF#07875718. EB 06/25/21" and we already crossed
As per notes dated 05/20/2021 - "CALLED ZURICH @ 719

590-8719 AND SPOKE W/ PRINCESS WHO STATED THAT
THERE`S NO BILL ON FILE. FAXED BILL TO 847 240-8172 ,
$60.49 CALL REF# 07727354. EB 05/20/21" Timely To Adjust
As per notes dated 05/20/2021 - "CALLED ZURICH @719

5590-8712 AND SPOKE W/ REP WHO STATED CLAIM WAS
DENIED BC EMPLOYEE SIGNED WAIVER THAT HE DID NOT
SUSTAIN INJURY DURING EMPLOYMENT. WILL SEND OUT
FOR COLLECTIONS. CALL REF#07728177. EB 05/20/21" and
$323.28 we already crossed the TFL Timely Client Assist
As per notes dated 05/27/2021 - "CALLED ZURICH @ 719
590-8719 AND SPOKE W/ CHAIRA WHO STATED THAT
THERE`S NO BILL ON FILE. FAXED BILLS TO 847 240-8172 ,
CALL REF# 07757058. EB 05/27/21" and we already crossed
Call
$206.12 Unable to get the claim status in webportal To call Calling
As per notes dated-11/07/2022-Called to Employer OCIP-

AIRPORT (HARTSFIELD JACKSON ATLANTA INTERNATIONAL
AIRPORT -HJAIA) [FC 8913 CONCOURSE T NORTH EXT] @404
375 5911 Concern person not active on call so call route to
voicemail, waiting for the response.
$517.06 voice mail need to call



8719 speak with Joycelyn stated that claim denied as Policy
not belongs to Insurance need to contact with the employer
OCIP-AIRPORT @ 404 375 5911 call route to Voice mail,
Need to wait for the response Ref#11138355

8719 speak with Joycelyn stated that claim denied as Policy
not belongs to Insurance need to contact with the employer
OCIP-AIRPORT @ 404 375 5911 call route to Voice mail,
Need to wait for the response Ref#11138355
As per notes dated-12/21/2022-Called ZURICH @719-590-

8719 spoke with Krish per rep no injury reported so called
employer @770-300-6828 / 470-897-4693 said forwarded
your details to my senior will assist you after some days, also
called Supervisior @ 770-308-6895 but did not connected.
$619.87 AR12212022. voice mail need to call
As per notes dated-12/21/2022-Called ZURICH @719-590-

8719 spoke with Krish per rep no injury reported so called
employer @770-300-6828 / 470-897-4693 said forwarded
your details to my senior will assist you after some days, also
called Supervisior @ 770-308-6895 but did not connected.
AR12212022.
As per notes dated-09/26/2022-Check on EMR Injury is not

reported yet contact to employer for further action call
NOVOLEX COMPANY - BAGCRAFT @ 770-300-6820 Concern
persen not active on call , Call routed to the voice mail desk,
so Email bills to Employer @ ap.invoice@novolex.com to
$281.97 process the payment. voice mail need to call
As per notes dated-09/26/2022-Check on EMR Injury is not

reported yet contact to employer for further action call
NOVOLEX COMPANY - BAGCRAFT @ 770-300-6820 Concern
persen not active on call , Call routed to the voice mail desk,
so Email bills to Employer @ ap.invoice@novolex.com to
$145.27 process the payment. voice mail need to call
DOW Name
12/21/2022 Askar Ali

12/27/2022 Sriram

eed to resubmit

12/27/2022 Sriram
12/27/2022 Sriram
12/27/2022 Sriram


oding Assistance
oding Assistance
oding Assistance
oding Assistance



oding Assistance




oding Assistance


12/27/2022 Sriram
12/27/2022 Sriram
12/27/2022 Sriram
12/27/2022 Sriram
eed to verify and post the payment


Adjust: Patientname Carriername Ptothercarrierssn/Claim# Doi Dos Tos

Uploaded by

Copyright:

Available Formats

You might also like

Adjust: Patientname Carriername Ptothercarrierssn/Claim# Doi Dos Tos

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Adjust: Patientname Carriername Ptothercarrierssn/Claim# Doi Dos Tos

Uploaded by

Copyright:

Available Formats

Adjust

PatientName CarrierName PTOtherCarrierSSN/Claim# DOI DOS TOS

MILLER. ZACK ZURICH N/A 2840323628 8/25/2021 8/25/2021 WC

GOMEZ. JUAN ZURICH MEDRISK 2840338970001 10/20/2022 11/11/2022 WC

DOUGLAS. STEVEN ZURICH MEDRISK 2840338644 10/13/2022 10/13/2022 WC

DOUGLAS. STEVEN ZURICH MEDRISK 2840338644 10/13/2022 10/27/2022 WC

DOUGLAS. STEVEN ZURICH MEDRISK 2840338644 10/13/2022 11/2/2022 WC

HO. BA ZURICH ALIGN NETWOR 2840339326 9/29/2022 11/2/2022 WC

OMAR. WASSAN ZURICH N/A xxx-xx-9999 2/16/2021 10/30/2022 WC

MILLER. ZACK ZURICH N/A 2840323628 8/25/2021 8/25/2021 WC

NGUYEN. QUAT ZURICH N/A 2840329966 2/17/2022 3/7/2022 WC

NGUYEN. QUAT ZURICH N/A 2840329966 2/17/2022 3/14/2022 WC

ESTRADA. JAVIER TRAVELERS N/A 2230539899 4/25/2022 4/27/2022 WC

ESTRADA. JAVIER TRAVELERS N/A 2230539899 4/25/2022 5/2/2022 WC

CORREA CHAVEZ. TO ZURICH N/A 2230520215 11/16/2021 11/16/2021 WC

HIDALGO. LANIER ZURICH N/A 2230566070 10/28/2022 11/7/2022 WC

DUDLEY. JAMES ZURICH N/A 2840336321 8/10/2022 9/1/2022 WC

JANO. FAYAD ZURICH ALIGN NETWOR 2230563763 10/4/2022 10/18/2022 WC

JANO. FAYAD ZURICH ALIGN NETWOR 2230563763 10/4/2022 10/24/2022 WC

JANO. FAYAD ZURICH ALIGN NETWOR 2230563763 10/4/2022 10/28/2022 WC

MUSE. ASHA ZURICH MEDRISK 2230564520 10/16/2022 10/19/2022 WC

MUSE. ASHA ZURICH N/A 2230564520 10/16/2022 10/21/2022 WC

MUSE. ASHA ZURICH N/A 2230564520 10/16/2022 10/28/2022 WC

MUSE. ASHA ZURICH N/A 2230564520 10/16/2022 11/11/2022 WC

OMAR. WASSAN ZURICH N/A xxx-xx-9999 2/16/2021 8/28/2021 WC

SPANN. JEREMY ZURICH N/A 2840308588 7/20/2020 7/20/2020 WC

JACKSON. JOHN ZURICH MEDRISK 2840333576 6/1/2022 6/1/2022 WC

BARNES. BENJAMIN ZURICH AMERICAN/A 2840335390 7/14/2022 7/20/2022 WC

LESINI. TERESA ZURICH N/A 2230557787 8/31/2022 9/6/2022 WC

LESINI. TERESA ZURICH N/A 2230557787 8/31/2022 9/21/2022 WC

BEASLEY. COURTNEY ZURICH ALIGN NETWOR 2840339822 11/9/2022 11/12/2022 WC

DURAN LOPEZ. ALEJ ZURICH N/A WC 2230552732 7/28/2022 7/28/2022 WC

GALICIA GOMEZ. MARZURICH N/A 2840325193 10/13/2021 10/22/2021 WC

MARTINEZ. LORENZOZURICH N/A 2230556091 8/18/2022 9/26/2022 WC

PEREZ. FERNANDO ZURICH ALIGN NETWOR 2230468104 10/7/2020 12/23/2020 WC

ROMAN. MATEO ZURICH MEDRISK 2230556342 8/23/2022 8/23/2022 WC

ROMAN. MATEO ZURICH N/A 2230556342 8/23/2022 8/25/2022 WC

ROSALES. ALFREDO ZURICH N/A 2230551548 7/20/2022 7/28/2022 WC

GARDUNO. RODOLFOZURICH MEDRISK 2840319305001 5/11/2021 5/13/2021 WC

GARDUNO. RODOLFOZURICH MEDRISK 2840319305001 5/11/2021 5/26/2021 WC

ZEPEDA SOLORZANO. ZURICH N/A 2840328700001 1/18/2022 2/9/2022 WC

EXANTUS. JEREMIAH ZURICH N/A 2230529552 2/2/2022 2/14/2022 WC

NAQIB. SAMIULLAH ZURICH N/A 2230521725001 11/25/2021 12/1/2021 WC

NAQIB. SAMIULLAH ZURICH N/A 2230521725001 11/25/2021 5/22/2022 WC

HIDALGO. LANIER ZURICH N/A 2230566070 10/28/2022 11/14/2022 WC

FULFORD. JOSEPH ZURICH N/A 2230562684 9/19/2022 10/18/2022 WC

MANNING. CHRISTOPZURICH ALIGN NETWOR 2840337275 9/9/2022 10/31/2022 WC

JAMES. SULLIVAN ZURICH N/A 2840321371 6/24/2021 7/28/2021 WC

TOLENTINO. JOSE ZURICH N/A 2840318799 4/27/2021 4/27/2021 WC

THAPA. DEVI ZURICH N/A 2230493537 5/7/2021 5/7/2021 WC

ALPINE. ZACHARY ZURICH MEDRISK xxx-xx-9999 9/12/2022 9/14/2022 WC

MUCKLE. WINSTON ZURICH N/A 2840333099 5/18/2022 6/1/2022 WC

ARRIETA-JIMENEZ. CI ZURICH MEDRISK 2230487532 2/21/2021 3/9/2021 WC

RODRIGUEZ. MARTINZURICH N/A 2230528428 1/26/2022 1/28/2022 WC

RUIZ. JOSE RAMIRO ZURICH N/A 2230553911 8/5/2022 8/5/2022 WC

RUIZ. JOSE RAMIRO ZURICH N/A 2230553911 8/5/2022 8/9/2022 WC

RUIZ. JOSE RAMIRO ZURICH N/A 2230553911 8/5/2022 8/15/2022 WC