Notes
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PATIENT NAME: BEUERLEIN, KURT A
MRN: E458382
GUARANTOR NAME: Kurt Beuerlein
ACCOUNT #: 102102389
Spoke to: / Website accessed: Web
Call Ref #: N/A
Claim Paid date: 02/01/2022
EFT #: VP12521255
Single check amt: $$142.08
Remit date: 02/07/2022
Remit located in RevLink (Y/N): N
Check located in RevLink (Y/N): N
Invoice #: MC424292390
Invoice payment: $142.08
Check cleared bank Y/N: Y
Date check cleared: 02/07/2022
Address remit was sent to: PO BOX 631332 CINCINNATI OH 45263
Notes: Checked Epic/Revlink no EOB found, Check claim on UMR portal fond that Ins receivced claim# 22023102283 was processed on 02/01/2022 for CPT- allowed $164.58 paid $114.58 and $50.00 applied towards Co-pay. CPT- allowed and paid $27.50. through single EFT# was cleared on . Hence EOB sent to Payement team.
REFERENCE NUMBER: N/A
SYSTEM ACTION: Sent to Payment Posting Team
TRANSFERRED TO: Payment Team"
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