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Hospital Billing 2nd Edition by Susan Magovern,Jean Jurek
Edition 2ISBN: 978-0073520896Hospital Billing 2nd Edition by Susan Magovern,Jean Jurek
Edition 2ISBN: 978-0073520896 Exercise 9
Fill in FLs 50-65 below for patient Renee Chang, given the following insurance and patient information. Note that this is a replacement claim. The insurance carrier information on the previous claim was incorrect. The hospital's NPI is 3322100065.Insurance Information
Patient Information
Primary: Medicare
Patient's Name: Renee Chang
Plan ID/Carrier Code: 00308
Insured's Name: Simon Chang
Release of Info on File: Y
Patient Relationship to Insured: Wife
Benefits Assigned: Y
Insured's Plan ID: 099256666
Preauthorization Number:-
Insurance Group Name/No:-
Provider ID: 070089
Employer:-
DCN: ZZ50062J3
UB-04 Form - FLs 50-65
974_13_181_Q_2
Patient Information
Primary: Medicare
Patient's Name: Renee Chang
Plan ID/Carrier Code: 00308
Insured's Name: Simon Chang
Release of Info on File: Y
Patient Relationship to Insured: Wife
Benefits Assigned: Y
Insured's Plan ID: 099256666
Preauthorization Number:-
Insurance Group Name/No:-
Provider ID: 070089
Employer:-
DCN: ZZ50062J3
UB-04 Form - FLs 50-65
974_13_181_Q_2
Explanation
Verified
Verified
Hospital Billing 2nd Edition by Susan Magovern,Jean Jurek
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