Claim:
, ()
BLUE CROSS BLUE SHIELD OF ALABAMA Provider
Proc Date
Code
—
02/07/22
19318
Policy #:
Processed as Primary Plan Type: 12 Claim Version: — Payer Claim #
Units
Billed
Allowed
Paid
1
12,708.72
1,559.00
1,559.00
Adj
Reason Code
Reason Code
PT Resp
Remark
11,149.72 CO-45
—
02/07/22
19318 50
1
6,354.36
779.50
5,574.86
779.50 CO-45
Claim Totals:
19,063.08
2,338.50
Payer Comments
2,338.50
16,724.58
0.00
Bill Balance Overview No Claim is associated to claim payment
Claim:
, ()
BLUE CROSS BLUE SHIELD OF ALABAMA Provider
Proc Date
Code
—
02/07/22
19318 50
Policy #:
Plan Type: 12 Claim Version: — Payer Claim #
Units
Billed
1
-12,708.72
Allowed
Paid
Adj
Reason Code
Reason Code
PT Resp
Remark
-11,929.22
-779.50 CO-45
Claim Totals:
Payer Comments
-12,708.72
0.00
-779.50
-11,929.22
0.00
Bill Balance Overview No Claim is associated to claim payment
https://mprs.ema.md/ema/practice/financial/Financials.action#/postPayments/era/era/prePost/web/1329560
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