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Play Froggy Jumps
1. PT balance
A
300
B
$0
C
$203
2. PT DOB
A
07/27/1980
B
07/26/1990
C
07/27/1890
3. PT Acct ID
A
24278285
B
24258267
C
24258285
4. PT PRIMARY INS
A
EMBLEMHEALTH
B
EMPIRE PLAN
C
MEDICARE
5. PT SECONDARY INS
A
N/A
B
EMPIRE PLAN
C
EMBLEM HEALTH
6. MEMBER ID
A
K6078278002
B
J6078290987
C
K6078290002
7. DOS
A
01/13/2023
B
07/27/2023
C
01/13/2022
8. TYPE OF VISIT
A
READIOLOGY VISIT
B
LAB VISIT
C
OFFICE VISIT
9. CLAIM WAS PROCESSED BY THE INS ?
A
YES
B
NO
C
IN PROCESS
10. WAS THE CLAIM DENIED BY THE INS?
A
NO
B
YES
C
NOT PROCESSED
11. WHY WAS THE CLAIM RE PROCESSED BY THE INS?
A
UNCOVERED SERVICE
B
PT INELEGIBLE
C
DOB DOES NOT MATCH
12. DID THE INS PAID FOR THE CLAIM?
A
YES
B
NO
C
NOT PROCESSED YET